Planned during the zenith aaa repair of a abdominal aneurysm was the addition of a main body extension deployed distal to the contralateral leg graft. The use of the extension was for added length in the common iliac artery and to seal the large iliac aneurysm in the vessel without occluding the internal iliac artery. Left internal iliac artery had previously been embolized. Post deployment angiogram noted a distal type iii endoleak, thought to have resulted form a "guttering" effect of the two grafts at the junction of the contralateral iliac leg graft and the main body extension. An iliac leg graft was deployed with the two grafts promoting a seal of the vessel and eliminating of the endoleak. Procedure was concluded noting patency of the left internal iliac, and renal arteries.

When selecting an extension to be deployed distal to the iliac leg graft, the intended fixation site and the diameter of the existing component to be docked must be considered. Careful consideration of the graft-to-graft and graft-to vessel fixation and seal need to be given in order to avoid endoleaks. Excessive oversizing may result in incomplete expansion, kinks or longitudinal folds in the graft causing endoleaks due to an incomplete seal. An evaluation of the incident found the planning and sizing of the endovascular graft to be the promary factor in the complications encountered. The use of a main body extension in the iliac artery, is an off-label use of the component.