A Technique for Endograft Relining of a Type IV Endoleak Using a Surgeon-Modified Internal Gate

Type IV endoleaks represent a rare etiology of late endograft failure; however, depending on the location, they can be extremely challenging to repair with endovascular solutions. We present a method of endograft relining that preserves antegrade limb perfusion, avoids extra-anatomic reconstructions, and ensures complete endograft exclusion.