Folding procedure to diminish type 3 endoleakage after open stent graft surgery with TEVAR extension

  • Tatushi OnzukaEmail author
  • Kojiro Furukawa
  • Eiki Tayama
  • Shigeki Morita
  • Akira Shiose
How to Do It


We herein report a new procedure to prevent type 3 endoleakage (EL3) after open stent graft (OSG) surgery with thoracic endovascular aortic repair (TEVAR) extension. The OSG Dacron graft portion is reversed and folded inside the OSG stent graft portion intraoperatively, filling the crack between the OSG and TEVAR device. We applied this procedure in two patients with no postoperative complications. Our folding procedure may prevent EL3 after OSG surgery if TEVAR extension is needed in the future.


Open stent graft Frozen elephant trunk Type 3 endoleak TEVAR 



We thank Angela Morben, DVM, ELS, from Edanz Group (, for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

Tatushi Onzuka, Kojiro Furukawa, Eiki Tayama, Shigeki Morita, and Akira Shiose declare that no conflict of interest exists.


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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular Surgery, Clinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuokaJapan
  2. 2.Department of Cardiovascular SurgeryKyushu University HospitalFukuokaJapan

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