A case of type Ⅲb endoleak with stent fracture after AFX stent graft with endovascular treatment

•Type IIIb endoleak is a very rare complication of endovascular aortic aneurysm repair and can be difficult to treat.•Postoperative evaluation seems to be very important and abdominal ultrasonography is a valuable diagnostic module.•To properly treat this complication, the proximal and distal seal zones must be adequate, fixation must be secure, and the components must sufficiently overlap. Type IIIb endoleak is a complication of endovascular repair of abdominal aortic aneurysms. The frequency of a type Ⅲb endoleak is approximately 0.23%. Because of its rarity, it poses diagnostic and treatment challenges. A 72-year-old man underwent endovascular repair of an abdominal aortic aneurysm with an AFX with DuraPly™ (Endologix LLC, Irvine, CA, USA). One year later, he developed a type IIIb endoleak with rapid re-expansion of the aortic aneurysm due to stent fracture of main body of AFX. He then underwent a second AFX endovascular repair; however, one month after, follow-up ultrasonography showed blood flowing into the abdominal aortic aneurysm from the site of the previous type IIIb endoleak. A third endovascular repair was performed using an Excluder® (W. L. Gore & Associates, Newark, DE, USA); fortunately, during the six-month follow-up, the endoleak did not recur and the diameter of the aneurysm did not enlarge. Type IIIb endoleak is a very rare complication of endovascular aortic aneurysm repair and can be difficult to treat. However, it is essential to ensure that the proximal and distal seal zones are adequate, fixation is secure, and the components sufficiently overlap.