The diagnostic and treatment challenge of type IIIb endoleaks

Type IIIb endoleak is a rare complication of endovascular aortic repair caused by endoprosthesis deterioration, leading to aneurysm pressurization and potential rupture. Because of its rarity, few cases are published. We report six cases of type IIIb endoleak in a 15-year period. Appropriate preoperative diagnosis was achieved in five cases; duplex ultrasonography, computed tomography angiography, and contrast-enhanced ultrasonography were useful diagnostic tools in one case, and angiography led to the correct diagnosis in four cases. In the remaining case, only surgical exploration identified the type IIIb endoleak. Successful treatment was achieved by endovascular relining in five cases and by surgical conversion in one case.