Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair

A 74-year-old man receiving long-term anticoagulation therapy for intermitt ent atrial fibrillation had a type II endoleak after endovascular abdominal aortic aneurysm repair. During an 8-month follow-up, the endoleak persiste d, and the aneurysm failed to decrease in diameter. By means of a left flan k retroperitoneal endoscopic surgical approach, the aneurysm was dissected free, and the lumbar arteries emanating from the aneurysm, as well as the i nferior mesenteric artery, were ligated with titanium clips. A postoperativ e spiral computed tomography scan depicted one pair of unclipped lumbar art eries just proximal to the aortic bifurcation. After immediate reoperation with the same approach, complete thrombosis of the aneurysm sac was radiogr aphically confirmed.