A Tear in the Zenith t-Branch: Symptomatic Type IIIb Endoleak

A 76 year old woman underwent an emergency repair for a ruptured type V thoraco-abdominal aortic aneurysm using a Zenith t-Branch (Cook Medical, Bloomington, IN, USA). Completion and 30 day computed tomography angiography (CTA) showed satisfactory aneurysm exclusion without endoleak (A). Two months later, chest pain and dyspnoea prompted a further CTA, revealing a fabric tear between the second and third Z stents. This type IIIb endoleak, at the location where the t-Branch device bowed into the sac, suggested mechanical stress failure (B, red arrow). Urgent relining using a 37 x 37 x 150 mm Gore TAG (W.L. Gore, Newark, DE, USA) achieved exclusion. The patient was discharged on post- operative day five on dual antiplatelet therapy. The one month follow up CTA confirmed exclusion