A peculiar case of type 1 endoleak after nellix endovascular aneurysm sac sealing. Clinical presentation and management

We report a case of type 1 endoleak with an outflow via a lumbar artery (LA) following Nellix endovascular aneurysm sealing (EVAS) to discuss the specific peculiarities and management of this complication. A 64-year-old man (acetylsalicylic acid 3) underwent Nellix EVAS for an asymptomatic infrarenal aortic aneurysm. The 6-month duplex scanning ultrasound and magnetic resonance imaging showed a type IA endoleak with an outflow via an LA combined with a stable aneurysmal sac size. The subsequent 9-month imaging controls showed no changes of the endoleak cavity, but there was a slight enlargement in proximal neck size associated with the distal migration of both Nellix grafts. Thus, catheter-directed embolization with detachable coils first of the LA origin and then of the endoleak cavity was carried out. Postoperative course was uneventful. The patient is endoleak free with stable sac size on 6-month computed tomography imaging investigations following the secondary intervention