Type 1A Endoleak correction with parallel stenting and plugging of O-ring lack of adherence

Endovascular aneurysm repair (EVAR) has become the preferred treatment for infrarenal abdominal aortic aneurysms, largely due to its minimally invasive nature and lower associated morbidity and mortality compared to traditional open surgical methods. The Ovation Abdominal Stent Graft System, introduced in 2010, features a unique sealing ring filled with polymer located 13 mm below the renal arteries. Its latest iteration, the Ovation Alto, improves this design by repositioning the sealing ring to 7 mm from the top of the graft fabric. Despite these advancements, complications such as Type 1A endoleaks (T1AEL) remain a concern, as they jeopardize the success of the repair. This report discusses an 82-year-old male patient who developed a T1AEL following an EVAR procedure with an Ovation endoprosthesis and underwent a successful endovascular intervention to achieve aneurysm exclusion. Imaging revealed a T1AEL caused by elliptical lack of adherence of the polymer O-ring, along with an increase in aortic diameter to 40 mm at O-ring level. Given the patient's high surgical risk due to severe chronic obstructive pulmonary disease, a minimally invasive strategy was pursued, involving gutter catheterization, ballon expandable stenting of the gutter and subsequent plugging. Finally, inferior mesenteric artery embolization. The procedure, performed under local anesthesia, was successful, with postoperative imaging confirming effective aneurysm exclusion and T1AEL resolution. This case underscores the feasibility of tailored endovascular solutions in high-risk patients and highlights the importance of individualizing treatment plans based on anatomical and pathological considerations.