Bilateral Type IIIa Endoleak and Disconnection of Both Limbs after Evar with an Endurant II Endograft

A 75-year-old patient with severe comorbidities was treated with an Endurant (Medtronic, USA) II endograft due to a ruptured abdominal aortic aneurysm (AAA). After four years of unremarkable follow-up, bilateral limb separation was detected. The patient underwent endovascular bridging without any complication. Although rarely detected in newer grafts, late bilateral type IIIa endoleaks can present and should be promptly repaired. Complex or ruptured AAAs treated with off-label use of endografts should be under closer surveillance using imaging tools for potential endoleaks or aneurysm sac growth.