A Novel Combined Microsurgical and Endovascular Approach for Type II Endoleak Embolization Through Direct Puncture of a Lumbar Segmental Artery: A Technical Case Instruction.

Background and importance: Despite the advances in endovascular aortic repair techniques, type II endoleaks with aneurysm sac expansion remain frequent and challenging problems.

Clinical presentation: An elderly gentleman underwent a combined microsurgical and endovascular procedure to address a type 2 endoleak and the growth of a recurrent abdominal aortic aneurysm caused by direct puncture of a lumbar segmental artery. The patient tolerated the procedure well and was discharged without complications. Follow-up imaging revealed no further endoleak and a smaller aneurysm size.

Conclusion: This unique case presents a novel multidisciplinary surgical strategy for treating complex, recurrent aortic aneurysms with type II endoleaks. The approach is tailored to the individual patient and has shown effectiveness. Long-term follow-up data will be crucial for assessing the efficacy and durability of this approach.