[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-415551-105":59,"doc-detail-415551-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","explantation-of-fenestrated-endograft-complicated-by-complete-junctional-dissociation-and-symptomatic-type-iiia-endoleak","Explantation of Fenestrated Endograft Complicated by Complete Junctional Dissociation and Symptomatic Type IIIa Endoleak","","A 67-year-old man presented with severe, acute-onset back pain and was found on computed tomography to have a type IIIa endoleak caused by complete junctional dissociation of his prior fenestrated endograft between visceral and bifurcated components. The perpendicular configuration of the dissociated stent grafts made endovascular salvage infeasible, leading to open explantation and aortic repair. Preoperative workup included a positive cardiac stress test, prompting coronary stenting, and subsequent surgery followed an uncomplicated hospital course.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/explantation-of-fenestrated-endograft-complicated-by-complete-junctional-dissociation-and-symptomatic-type-iiia-endoleak/415551/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/explantation-of-fenestrated-endograft-complicated-by-complete-junctional-dissociation-and-symptomatic-type-iiia-endoleak/415551.png","ImageObject",300,407,{"name":92,"@type":93},"Quinn Holloway","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What condition led to the need for explantation in this case?","Question",{"text":112,"@type":113},"Computed tomography showed a symptomatic type IIIa endoleak due to complete junctional dissociation of the prior fenestrated endograft.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why was an endovascular salvage approach not feasible?",{"text":117,"@type":113},"The dissociated stent grafts had a perpendicular configuration, which precluded a safe endovascular approach.",{"name":119,"@type":110,"acceptedAnswer":120},"What additional cardiac evaluation and treatment were performed before aortic surgery?",{"text":121,"@type":113},"A dobutamine stress test was positive for inducible ischemia, leading to coronary artery stenting of a 99% left anterior descending lesion before the aortic operation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},415551,1790695228,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},2336474466712,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Explantation of fenestrated endograft complicated by complete junctional dissociation and symptomatic type IIIa endoleak  \nDaemar H. Jones, MD, Nicole A. Heidt, MD, Laura B. Pride, MD, Chandler A. Long, MD, and Young Kim, MD, MS, Durham, NC  \nABSTRACT  \nIn this report, we present a 67-year-old man who was transferred from an outside facility with complaints of severe back pain. Computed tomography imaging demonstrated a type IIIa endoleak with complete junctional dissociation of his prior fenestrated endograft, between the visceral and the bifurcated components. Given the perpendicular configuration of the dissociated stent grafts, no endovascular salvage was feasible, and open explantation was indicated. His preoperative evaluation was significant for a positive cardiac stress test warranting coronary artery stenting. The patient underwent subsequent open graft explantation and aortic repair, and was ultimately discharged home after an uncomplicated hospital course. (J Vasc Surg Cases Innov Tech 2026;12:102065 . )  \nKeywords: Endoleak; Fenestrated endovascular aneurysm repair; Graft explantation  \nThe optimal approach to abdominal aortic aneurysm (AAA) repair (ie, open vs endovascular) remains a topic of active discourse. Since the introduction of endovascular aneurysm repair (EVAR), treatment patterns have shifted toward less invasive management. However, long-term data from the EVAR-1 and DREAM trials indicate that, although EVAR offers lower perioperative morbidity, open repair may confer superior long-term survival.1,2 These findings, along with the requirement for lifelong imaging surveillance after EVAR, have renewed interest in open repair, especially among younger patients. We present a late complication of endovascular repair in a patient who underwent the procedure in his 50s. The patient provided consent for publication.  \nCASE REPORT  \nA 67-year-old man presented to an outside facility with severe, acute-onset back pain. Abdominal plain films revealed an unexpected finding of misoriented abdominal endografts (Fig 1), prompting transfer to our institution for a higher level of care. On arrival, he was hemodynamically stable with moderate back pain. Further history revealed a prior history of ajuxtarenal AAA treated with a Zenith Fenestrated AAA Endovascular Graft (ZFEN; Cook Medical) and a stent to the left accessory renal artery, placed 10 years earlier. Per operative report documentation, the initial AAA measured 5.8 cm, and the patient was asymptomatic. The aneurysm was first identified on an aortic  \nFrom the Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University.  \nCorrespondence: Young Kim, MD, MS, Assistant Professor of Surgery, Division of Vascular and Endovascular Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710 ([e-mail:](e-mail: y.kim@duke.edu)[ y.kim@duke.edu](e-mail: y.kim@duke.edu)) .  \nThe editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.  \n2468-4287  \n© 2025 The Author(s) . Published by Elsevier Inc. on behalf of Society for Vascular Surgery. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) .  \n[https://doi.org/10.1016/j.jvscit.2025.102065](https://doi.org/10.1016/j.jvscit.2025.102065)  \nduplex, which reported a size of 6.3 cm . The indication for the duplex is not documented. He had since been lost to followup without interval surveillance imaging.  \nComputed tomography confirmed marked graft malorientation consistent with a type IIIa endoleak (Fig 2) . On center-line imaging, the proximal seal zone measured 15 mm proximal to the accessory left renal artery. The right and main left renal arteries were at the same level proximal to this, and the superior mesen","cbCaitVUlYCJiMYm","https://ap.wps.com/l/cbCaitVUlYCJiMYm","pdf",4376992,"English","# Abstract\n# Case Report","[{\"question\":\"What condition led to the need for explantation in this case?\",\"answer\":\"Computed tomography showed a symptomatic type IIIa endoleak due to complete junctional dissociation of the prior fenestrated endograft.\"},{\"question\":\"Why was an endovascular salvage approach not feasible?\",\"answer\":\"The dissociated stent grafts had a perpendicular configuration, which precluded a safe endovascular approach.\"},{\"question\":\"What additional cardiac evaluation and treatment were performed before aortic surgery?\",\"answer\":\"A dobutamine stress test was positive for inducible ischemia, leading to coronary artery stenting of a 99% left anterior descending lesion before the aortic operation.\"}]","Explantation of Fenestrated Endograft Complicated by Complete Junctional Dissociation and Symptomatic Type IIIa Endoleak | PDF",1790601846]