As I had discussed earlier posts, endoleaks can be managed with superselective endovascular access of the AAA sac via the hypogastric artery (Link) or the superior mesenteric artery (Link), but in fact, it may be very easily treated with direct ligation. This patient had a Type II leak causing sac growth from an IMA source and I chose to treat this laparoscopically. The patient was placed in a right lateral decubitus position to use gravity to move the small bowel away from the aorta. An umbilical and left midaxillary line port were placed after pneumoperitoneum was induced. The view above shows the IMA which is readily seen in the retroperitoneum. Ligating it with clips effectively closes the endoleak.
The before and after CT scans show that the endoleak resolves after ligation. This takes about 15-30 minutes of operating.