1
|
Roditis K, Tsiantoula P, Giannakopoulos NN, Antoniou A, Papaioannou V, Tzamtzidou S, Manou D, Seretis KG, Papas TT, Bessias N. Laparoscopic Ligation of the Inferior Mesenteric Artery: A Systematic Review of an Emerging Trend for Addressing Type II Endoleak Following Endovascular Aortic Aneurysm Repair. J Clin Med 2024; 13:2584. [PMID: 38731113 PMCID: PMC11084248 DOI: 10.3390/jcm13092584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing a type II endoleak following endovascular aortic aneurysm repair (EVAR). Methods: A comprehensive literature search was conducted across several databases including Medline, Scopus, and the Cochrane Central Register of Controlled Trials, adhering to the PRISMA guidelines. The search focused on articles reporting on the laparoscopic ligation of the IMA for the treatment of a type II endoleak post-EVAR. Data were extracted regarding study characteristics, patient demographics, technical success rates, postoperative outcomes, and follow-up results. Results: Our analysis included ten case studies and two retrospective cohort studies, comprising a total of 26 patients who underwent a laparoscopic ligation of the IMA between 2000 and 2023. The mean age of the cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period. Conclusions: The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.
Collapse
Affiliation(s)
- Konstantinos Roditis
- Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, 115 26 Athens, Greece; (P.T.); (N.-N.G.); (A.A.); (V.P.); (S.T.); (D.M.); (K.G.S.); (T.T.P.); (N.B.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
San Norberto EM, Fidalgo-Domingos LA, Romero A, Vaquero C. Total Laparoscopic Inferior Mesenteric Artery Ligation and Direct Sac Puncture Embolization Technique for Treatment of Type II Endoleak. Vasc Endovascular Surg 2019; 54:278-282. [PMID: 31752622 DOI: 10.1177/1538574419885271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Type II endoleak relates to aneurysm perfusion through a patent branch vessel. Reintervention for type II endoleak should be considered in the presence of significant aneurysm growth. Recurrences and subsequent reinterventions are frequent by occult type II endoleaks through feeder arterial branches. We report a case of a patient with a type II endoleak due to inferior mesenteric artery (IMA) patency associated with aneurysm sac growth after an unsuccessfully attempt of transarterial embolization. Laparoscopic ligation of the IMA with direct sac puncture embolization was performed. The postoperative and 1-year follow-up computed tomography angiography scan demonstrated no endoleak signs and aneurysm sac shrinkage. The proposed modification of this technique constitutes a novel approach to this entity. Total laparoscopic IMA ligation and direct sac puncture embolization technique may increase the success rate for the treatment of endoleaks type II by excluding the recurrences. This technique may offer a safe, feasible, and minimally invasive approach for type II endoleaks when other endovascular techniques are unsuccessful.
Collapse
Affiliation(s)
| | | | - Alejandro Romero
- Division of General Surgery, Valladolid University Hospital, Valladolid, Spain
| | - Carlos Vaquero
- Division of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| |
Collapse
|
3
|
Wee I, Marjot T, Patel K, Bhrugubanda V, Choong AMTL. Laparoscopic ligation of Type II endoleaks following endovascular aneurysm repair: A systematic review. Vascular 2018; 26:657-669. [PMID: 29966486 DOI: 10.1177/1708538118773611] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The clinical significance of Type II endoleak remains contentious; the strategies used for its management have continued to expand. We systematically review the literature and comprehensively appraise the effectiveness of laparoscopic intervention in the management of this common complication. METHODS A systematic search was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on MEDLINE, EMBASE and Cochrane Library for relevant articles reporting laparoscopic surgery of Type II endoleak post-endovascular aortic repair. RESULTS Thirteen studies representing 40 patients were investigated. Mean age was 72.7 years, and proportion of males was 90.0%. All patients were American Society of Anesthesiologists grade II and above and underwent standard infrarenal endovascular aneurysm repair. The mean duration of operation was 130.2 min, with a mean blood loss across of 173.8 mL. The overall technical success rate was 90% (27/30). Two patients required reoperation within 24 h, with further lumbar ligations that were successful. One other patient required conversion to open surgery due to significant bleeding at the dorsal aorta. The perioperative and 30-day mortality rate was 2.5% (1/40). The mean length of hospital stay was 3.7 days (range 1 to 10 days). The mean length of follow-up was 36.7 months (range 3 to 103.2 months), where the rate of recurrence was 22.5% (9/40). CONCLUSIONS Laparoscopic ligation of feeding vessels causing Type II endoleak is potentially an alternative treatment after failed standard endovascular embolization, particularly in select centres with necessary resources and capabilities.
Collapse
Affiliation(s)
- Ian Wee
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore
- 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Thomas Marjot
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore
- 3 Imperial College Healthcare NHS Trust, London, UK
| | - Kirtan Patel
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore
- 4 Southend University Hospital National Health Service Foundation Trust, Essex, UK
| | - Vamsee Bhrugubanda
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore
- 5 Lancashire Teaching Hospitals Trust National Health Service Foundation Trust, Preston, UK
| | - Andrew MTL Choong
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore
- 6 Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
- 7 Division of Vascular Surgery, National University Heart Centre, Singapore, Singapore
- 8 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
4
|
Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2017; 66:1878-1884. [PMID: 28822664 DOI: 10.1016/j.jvs.2017.07.066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/07/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Type II endoleak after endovascular aneurysm repair (EVAR) is frequently caused by persistent flow from the inferior mesenteric artery (IMA). The aim of this study was to assess the perioperative and midterm efficacy of laparoscopic ligation of the IMA for treatment of endoleak. METHODS MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane databases and key references were searched with Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology for studies reporting on laparoscopic ligation of the IMA for treatment of type II endoleak after EVAR. RESULTS Eight case studies and one study of a retrospective nature were identified. In total, 20 patients (18 men; mean age, 73.6 ± 2 years; with a mean abdominal aortic aneurysm diameter of 64.3 ± 10 mm) who underwent post-EVAR laparoscopic ligation of the IMA for type II endoleak were analyzed. The mean time from EVAR until intervention ranged from 6 to 18 months. All but one patient were asymptomatic; in 9, the aneurysm sac was enlarged, and in 11, the endoleak was considered persistent without sac enlargement. The mean procedural duration was 99 ± 24 minutes, with technical success rate of 90% (18/20); in two cases, the patients were successfully reoperated on laparoscopically in 24 hours. The mean hospitalization was 3.6 ± 1.2 days, with 0% (0/20) perioperative and 30-day mortality. No patient underwent open conversion or showed signs of intestinal ischemia. During follow-up of 32.6 ± 12 months, 13 of 20 patients had aneurysm sac regression, whereas the rest had a stable sac diameter without evidence of persistent type II endoleak. CONCLUSIONS Laparoscopic ligation of the IMA for treatment of type II endoleak after EVAR is a feasible and safe technique in specialized centers with high technical success rate and good midterm outcomes.
Collapse
|
5
|
Zubair MM, Chinnadurai P, Loh FE, Loh TM, Lumsden AB, Bechara CF. A novel technique combining laparoscopic and endovascular approaches using image fusion guidance for anterior embolization of type II endoleak. J Vasc Surg Cases Innov Tech 2017; 3:7-10. [PMID: 29349363 PMCID: PMC5757813 DOI: 10.1016/j.jvscit.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022] Open
Abstract
Type II endoleak (T2E) leading to aneurysm sac enlargement is one of the challenging complications associated with endovascular aneurysm repair. Recent guidelines recommend embolization of T2E associated with aneurysmal sac enlargement. Various percutaneous and endovascular techniques have been reported for embolization of T2E. We report a novel technique for T2E embolization combining laparoscopic and endovascular approaches using preoperative image fusion. We believe our technique provides a more direct access to the lumbar feeding vessels that is typically challenging with transarterial or translumbar embolization techniques.
Collapse
Affiliation(s)
- M. Mujeeb Zubair
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Ponraj Chinnadurai
- Angiography Division, Siemens Medical Solutions USA Inc, Hoffman Estates, Ill
| | - Francis E. Loh
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Thomas M. Loh
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Alan B. Lumsden
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Carlos F. Bechara
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Tex
| |
Collapse
|
6
|
Successful laparoscopic repair of refractory type Ia endoleak after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2015; 61:275-9. [DOI: 10.1016/j.jvs.2014.08.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022]
|
7
|
Almeida BLD, Kambara AM, Rossi FH, Colli MBDO, Oliveira ESJD, Metzger PB, Beteli CB, Cavalcante SFA. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair. J Vasc Bras 2014. [DOI: 10.1590/1677-5449.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.
Collapse
|
8
|
Brenes RA, Panait L, Abbas HMA, Tapias L, Tripodi G, Ajemian MS, Macaron SH. Prevention of type II endoleak by laparoscopic inferior mesenteric artery ligation. Surg Innov 2012; 20:NP6-8. [PMID: 22333935 DOI: 10.1177/1553350611432720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abdominal aortic aneurysm repair by endovascular techniques have gained wide acceptance as a treatment option. A potential well-known complication of endovascular repair includes endoleak. Specifically, type II endoleak, which is described as retrograde flow into the aneurysm sac through collateral vessels, can occur in up to 30% of patients. Certain preoperative factors can predict which patients may develop type II endoleak. This article describes laparoscopic inferior mesenteric artery ligation prior to endovascular abdominal aortic aneurysm repair as a viable treatment option in the prevention of type II endoleak.
Collapse
Affiliation(s)
- Robert A Brenes
- Department of Surgery, Saint Mary’s Hospital, Waterbury, CT 06706, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Schellhammer F, Cohnen M, Fürst G, Mödder U. Minimally invasive application of thrombin in the treatment of pseudoaneurysms following open aortic surgery. Acta Radiol 2011; 52:48-51. [PMID: 21498325 DOI: 10.1258/ar.2010.100201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anastomotic leaks are uncommon complications following aortic surgery. To avoid the morbidity associated with a second surgical procedure, minimally invasive techniques have become increasingly popular. PURPOSE To evaluate the feasibility and safety of thrombin in interventional treatment of postoperative pseudoaneurysms. MATERIAL AND METHODS CT-guided percutaneous injection was chosen in four cases. Endovascular access using an occlusion balloon catheter placed in the orifice of the pseudoaneurysm was utilized in one case. RESULTS The average volume of all pseudoaneurysms was 178 ± 190 mL with a volume of the patent lumen of 25 ± 28 mL. All aneurysms thrombosed after injection of 600 ± 237 IU of thrombin. During the follow-up period of an average of 10 months all pseudoaneurysms remained occluded. CONCLUSION Our series demonstrates the feasibility of thrombin in the treatment of aortic anastomotic pseudoaneurysms. In combination with occlusion balloon catheters, even wide-necked pseudoaneurysms may be treated successfully. However, further investigations are warranted.
Collapse
Affiliation(s)
| | | | - Günter Fürst
- Universitätsklinik Düsseldorf, Department of Radiology, Dusseldorf, Germany
| | - Ullrich Mödder
- Universitätsklinik Düsseldorf, Department of Radiology, Dusseldorf, Germany
| |
Collapse
|
10
|
Percutaneous Transosseous Embolization of Internal Iliac Artery Aneurysm Type II Endoleak: Report of Two Cases. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S122-5. [DOI: 10.1007/s00270-010-9809-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 12/08/2009] [Indexed: 10/19/2022]
|
11
|
Jonker FH, Aruny J, Muhs BE. Management of Type II Endoleaks: Preoperative versus Postoperative versus Expectant Management. Semin Vasc Surg 2009; 22:165-71. [DOI: 10.1053/j.semvascsurg.2009.07.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
12
|
Ward E, Buckley O, Collins A, Browne RF, Torreggiani WC. The use of thrombin in the radiology department. Eur Radiol 2008; 19:670-8. [PMID: 18925399 DOI: 10.1007/s00330-008-1198-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/23/2008] [Accepted: 08/29/2008] [Indexed: 01/26/2023]
Abstract
Thrombin is a naturally occurring coagulation protein that converts soluble fibrinogen into insoluble fibrin and plays a vital role in the coagulation cascade and in turn haemostasis. Thrombin also promotes platelet activation. In the last few years, there has been a rapid increase in the use of thrombin by radiologists in a variety of clinical circumstances. It is best known for its use in the treatment of pseudoaneurysms following angiography. However, there are now a variety of cases in the literature describing the treatment of traumatic, inflammatory and infected aneurysms with thrombin in a variety of locations within the human body. There have even been recent reports describing the use of thrombin in conventional aneurysms as well as ruptured aneurysms. Its use has also been described in the treatment of endoleaks (type II) following aneurysm repair. In nearly all of these cases, treatment with thrombin requires imaging guidance. Recently, thrombin has also been used as a topical treatment post-percutaneous intervention to reduce or stop bleeding. Most radiologists have only a limited knowledge of the pharmacodynamics of thrombin, its wide range of utilisation and its limitations. Apart from a few case reports and case series, there is little in the radiological literature encompassing the wide range of applications that thrombin may have in the radiology department. In this review article, we comprehensively describe the role and pathophysiology of thrombin, describing with examples many of its potential uses. Techniques of usage as well as pitfalls and limitations are also described.
Collapse
Affiliation(s)
- E Ward
- Department of Radiology, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
| | | | | | | | | |
Collapse
|
13
|
Hoffmann RT, Nikolaou K, Boekstegers P, Reichart B, Reiser MF. Minimally invasive repair of a left ventricular pseudoaneurysm after surgical patch reconstruction of an infarct-related free posterior wall rupture: CT-guided intervention. Cardiovasc Intervent Radiol 2007; 30:1010-2. [PMID: 17533544 DOI: 10.1007/s00270-007-9054-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 12/11/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022]
Abstract
Ventricular free wall rupture remains the most serious complication after acute myocardial infarction. In early-recognized, subacute cases a surgical intervention using patches can be lifesaving. However, in the rare case of postoperative patch leakage, a relapse of a pseudoaneurysm may occur. This is the first case in the literature--to the best of our knowledge--describing a minimally invasive strategy using CT fluoroscopic guidance to perform an injection of thrombin into the perfused pseudoaneurysm to seal a leakage. This therapeutical regimen was chosen--in accordance with cardiac surgeons, cardiologists, and interventional radiologists--due to the high risk of adverse event after repeated surgery in this particular patient. The follow-up images showed complete occlusion of the pseudoaneurysm after the thrombin injection. This approach could be discussed in a multidisciplinary setting in similar cases, especially due to the described negligible recurrence rate after successful initial thrombosis after treating femoral pseudoaneurysms, pseudoaneurysms of the pancreatic artery, or even endoleaks after stenting of aneurysms of the aorta.
Collapse
Affiliation(s)
- Ralf Thorsten Hoffmann
- Department of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | |
Collapse
|
14
|
Binkert CA, Alencar H, Singh J, Baum RA. Translumbar Type II Endoleak Repair Using Angiographic CT. J Vasc Interv Radiol 2006; 17:1349-53. [PMID: 16923983 DOI: 10.1097/01.rvi.0000231966.74734.7d] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Translumbar embolization of type II endoleaks after endovascular abdominal aneurysm repair has been proved to be effective. One challenge of this approach is the choice of the most suitable image guiding modality. For needle placement, cross-sectional imaging under computed tomographic (CT) guidance is preferable. For embolization, fluoroscopy is the modality of choice for most interventionalists. A new technology can acquire CT-like images by rotating an angiographic, flat-panel detector of a C-arm around the patient. This technology allows a combination of fluoroscopic and CT guidance within the angiographic suite. The authors describe the successful use of a combination of fluoroscopy and angiographic CT in three cases of translumbar type II endoleak embolization.
Collapse
Affiliation(s)
- Christoph A Binkert
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|