Sac Expansion with Vasa Vasorum-Related Type II Endoleak after Endovascular Aortic Repair Managed by Translumbar Direct Sac Embolization Using Glue

An 84-year-old man with an abdominal aortic aneurysm with a largest diameter of 50 mm was treated using endovascular aortic repair (EVAR) within the instructions for use. Computed tomography (CT) performed 3 years after the EVAR revealed significant sac expansion. The first (3 years after EVAR) and second (4 years after EVAR) transarterial embolizations demonstrated rare type II endoleaks from the vasa vasorum as multiple fluffy contrast blushes from the aortic tributaries. As sac expansion persisted at 5 years after the EVAR, translumbar direct puncture of the sac and embolization using a mixture of 25% n-butyl cyanoacrylate and lipiodol was performed. A follow-up CT 2 years after the last embolization showed sac stability without any complications.