An endurant ii stent graft and an aptus heli-fx endosystem was used for endovascular treatment.The diameter of aorta at the level of the renal artery measured 32 mm.The length of the proximal aortic neck measured 20 mm.The proximal aortic neck was angulated 75 degrees.The vessel was tortuous.There was no vessel calcification.It was reported that during the index procedure the plan was to prophylactically implant the endoanchors.However, due to the patient's anatomy, specifically a short, angulated and conical neck, a type i endoleak was seen on the right side after the endurant graft deployment.Six endoanchors were successfully implanted.At that point the guide sheath could no longer be used due to trouble advancing the applier through the sheath.The device was examined on the table top and the applier did go through outside the patient.The device was put back into the patient and another anchor was inserted.After deployment there was trouble with the guide sheath.It would not deflect.It was noted that this was tried both inside and outside the patient and it would not deflect in either environment.As a result, no additional endoanchors could be implanted.The type i leak was not resolved and it was noted that the patient may require additional endoanchors.Per the physician, the cause of the event was unknown.However, the patient had a one month follow up ct and the type ia endoleak had not resolved.An intervention was performed and 9 additional endoanchors were implanted.No endoleak was identified on the intra-operative arteriogram.Seven days later the final angiogram appeared to show that the endoleak was gone.The patient reportedly recovered well and was sent home the next day.No additional clinical sequelae were reported and the patient is being monitored by the physician.
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