J ENDOVASC THER 2002;9:203–207 203  2002 by the INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS Available at www.jevt.org  CASE REPORT  Endograft Fabric Disintegration Simulating a Type II Endoleak Jean-Pierre Becquemin, MD*; Bertrand Poussier, MD; Eric Allaire, MD, PhD; Hischam Kobeiter, MD; and Pascal Desgranges, MD, PhD Department of Vascular Surgery and Imaging, Ho ˆ pital Henri Mondor, Universite ´ Paris XII, Cre ´ teil, France   Purpose: To report a case of endograft disintegration misinterpreted as a type II endoleak. Case Report: An 86-year-old man underwent successful Vanguard stent-graft implantation for a 49-mm abdominal aortic aneurysm. At 1 month, a distal type I endoleak was repaired, but another endoleak thought to arise from the lumbar or inferior mesenteric arteries re- mained. Multiple interventions to embolize the feeding arteries were unsuccessful, and the endoleak persisted. At 1 year, the leak was still present, and the aneurysm had increased to 69 mm. After failing to demonstrate the source of the leak radiographically, surgery was performed. At operation, the endoleak was traced to small holes in the graft fabric. The endograft was removed without difficulty, and the flow was re-established with an aortobi- iliac woven graft. Conclusions: Chronically implanted stent-grafts can show signs of failure that are confus- ing or misleading. Correct diagnosis of endoleaks may be difficult, but every effort must be made to identify their source. It is vital that no enlarging aneurysm be left untreated. J Endovasc Ther 2002;9:203–207 Key words: graft rupture, Vanguard stent-graft, suture breakage, stent-graft disconnection, type III endoleak   This work was supported by ARCEV, the charity fund of the Department of Vascular Surgery and Imaging, Ho ˆ pital Henri Mondor, Paris, France. Address for correspondence and reprints: Jean-Pierre Becquemin, MD, Ho ˆ pital Henri Mondor, 51 av- enue du Mal de Lattre de Tassigny, 94010 Cre ´ teil cedex, France. Fax: 33-1-49-81-24-33, E-mail: jpbecquemin@hotmail.com Endovascular treatment of abdominal aortic aneurysms (AAA) has become popular among the medical community. With in- creased expertise in patient selection and technical skill and continuous improvement in the introducer systems and graft designs, be- tween 50% and 80% of AAA patients may be offered an endovascular option. Early results compare favorably with open surgery. 1 How- ever, long-term outcomes are still a matter of concern, with the frequent need for additional procedures to maintain graft patency and an- eurysm exclusion. 2 Recently, attention has been drawn to structural defects appearing in chronically implanted stent-grafts. 3 Graft rup- ture may lead to AAA rupture and death. 4 Be- sides the question of graft durability, the early recognition of graft deterioration is of para- mount importance, since prompt treatment may avoid a catastrophe. This report de- scribes a case of graft disruption that was mistakenly taken for a type II endoleak. CASE REPORT An 86-year-old man underwent successful AAA repair using a Vanguard stent-graft (Bos- ton Scientific, Natick, MA, USA) in June 1997.