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Sun Y, Cai HB, Yang D, Li WY, Zhao W, Hu JH, Li M, Peng MS, Yuan F, Qing KX. Volumetric analysis of effectiveness of embolization for preventing type II endoleaks following endovascular aortic aneurysm repair. J Vasc Surg 2023; 77:752-759.e2. [PMID: 36441022 DOI: 10.1016/j.jvs.2022.10.033] [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: 09/12/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The presence of endoleak was associated with the failure of endovascular aortic aneurysm repair (EVAR) treatment. The key to eliminating type II endoleak has shifted from reintervention to prevention. This study aimed to evaluate the effectiveness and safety of applying fibrin sealant to prevent type II endoleak in conjunction with EVAR. METHODS All patients with abdominal aortic aneurysm who underwent EVAR from June 2019 to July 2021 were reviewed. Patients were grouped as Group A: standard EVAR with preemptive embolization and Group B: standard EVAR alone. The primary endpoint was the incidence of type II endoleak. The secondary endpoints were aneurysm sac regression, the inferior mesenteric artery patency, the numbers of patent lumbar arteries, and all-cause mortality. RESULTS A total of 104 patients were included in Group A, and 116 were included in Group B. Technical success rate was 100%. The overall incidence of type II endoleak in Group A was significantly lower than that in Group B (4.8% vs 19.0%). The mean time of freedom from type II endoleak was 22.71 months for Group A (95% confidence interval, 21.59-23.83 months) and 19.89 months for Group B (95% confidence interval, 18.08-21.70 months). The Kaplan-Meier estimate of freedom from type II endoleak showed a significantly longer duration of freedom from type II endoleak in Group A (81.0% vs 95.2%). Group A showed a continuous sac regression tendency. In Group B, the sac volume decreased within 12 months but increased by 3.07 cm3 at 24 months. No complications were noted in both groups. CONCLUSIONS Nonselective preemptive embolization with porcine fibrin sealant during EVAR was safe and effective in preventing type II endoleak in the short and mid-term. Preemptive embolization can lead to a significantly higher sac regression rate. Larger patient populations and longer follow-ups with randomized control designed trials are expected to verify the long-term effectiveness and safety of preemptive embolization in preventing type II endoleak.
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Affiliation(s)
- Yuan Sun
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Hong-Bo Cai
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Di Yang
- The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Wei-Yi Li
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Wei Zhao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Ji-Hong Hu
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Min Li
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Ming-Sheng Peng
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Feng Yuan
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Kai-Xiong Qing
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China.
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Vance AZ, Graif A, Patel R, Chedrawy C, Chohan O, Garcia MJ, Kimbiris G, Leung DA. Outcome and technical evolution of type 2 endoleak embolization with ethylene-vinyl-alcohol copolymer. Vascular 2023; 31:10-17. [PMID: 35229689 DOI: 10.1177/17085381211053409] [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
PURPOSE This study aims to evaluate the safety and efficacy of novel approaches to type 2 endoleak access for the purpose of embolization using ethylene-vinyl-alcohol copolymer (EVOH) in patients with abdominal aortic aneurysm (AAA) sac expansion post endovascular abdominal aortic repair (EVAR). METHODS A retrospective review of 43 consecutive patients (mean age = 80.2 ± 6.7 years) who underwent 52 embolization procedures for type 2 endoleaks using EVOH was performed at a single institution. Catheterization of the endoleaks was achieved using the transarterial (TA) and direct translumbar approaches (DTL), in addition to the novel direct transabdominal (DTA) and perigraft (PG) approaches. Endpoints included technical success of endoleak catheterization, technical success of endoleak embolization, endoleak persistence, endoleak recurrence, AAA sac area change, and adverse events. RESULTS The TA, DTL, DTA, and PG approaches were used 25, 2, 14, and 19 times respectively, including nine procedures where a combination of approaches was used. The technical success rate of endoleak embolization was 98%. Five patients developed recurrent type 2 endoleaks, while five patients developed a type 1 endoleak. The persistent endoleak rate at a mean initial follow-up of 3 months was 34%. At a mean follow-up of 18 months, 58% of patients demonstrated absence of an endoleak, and 71% showed freedom from AAA sac enlargement. No major adverse events were recorded. CONCLUSION The DTA and PG approaches were safe and effective in this cohort of patients undergoing embolization of type 2 endoleaks with EVOH.
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Affiliation(s)
- Ansar Z Vance
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Assaf Graif
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
| | - Ramkrishna Patel
- Department of Vascular Interventional Radiology, Albany Medical Center, Albany, NY, USA
| | - Christelle Chedrawy
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
| | - Omar Chohan
- Great Lakes Medical Imaging, Buffalo, NY, USA
| | - Mark J Garcia
- Endovascular Consultants of Delaware, Wilmington, DE, USA
| | - George Kimbiris
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
| | - Daniel A Leung
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
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Le Q, Farivar BS. Long Term Monitoring of Thoracic Endovascular Aortic Aneurysm Repair Using Transcaval Aortic Access. Vasc Endovascular Surg 2022; 56:15385744221105357. [PMID: 35617123 DOI: 10.1177/15385744221105357] [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: 11/16/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has reduced the morbidity and mortality associated with the treatment of thoracic aortic pathologies. However, TEVAR's use is often predicated on sufficiently large femoral access for the delivery of the endograft device. Transcaval access, or the delivery of endovascular device via the vena cava before crossing into the aorta, has been used successfully for the deployment of transcatheter aortic valves. Our institution previously reported on a case of TEVAR using transcaval access. We now report on the long-term follow-up outcome of this case. At 6 years post-surgery, computed tomography angiography (CTA) indicates stable aortic repair without any concerning findings associated with the site of transcaval access into the aorta. The patient is clinically without signs of lower extremity vascular or cardiopulmonary compromise. Overall, transcaval access for TEVAR is a promising alternative to traditional femoral artery access in highly-select patients with the appropriate anatomical and pathological indications.
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Affiliation(s)
- Quang Le
- Division of Vascular and Endovascular Surgery, Department of Surgery, 12350University of Virginia Health System, Charlottesville, VA, USA
| | - Behzad S Farivar
- Division of Vascular and Endovascular Surgery, Department of Surgery, 12350University of Virginia Health System, Charlottesville, VA, USA
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Nolte-Ernsting C, Mecklenbeck FP, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. ROFO : FORTSCHRITTE AUF DEM GEBIETE DER RONTGENSTRAHLEN UND DER NUKLEARMEDIZIN 2021; 193:1426-1435. [PMID: 34139782 DOI: 10.1055/a-1502-7883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Type 2 endoleaks (T2EL) are the most frequent complication following endovascular aortic repair. Multiple studies primarily deal with the technical and clinical success of the embolization of persisting T2EL, thereby revealing controversial outcomes. Current reports rarely focus on the detailed execution of such a complex interventional procedure with respect to the difficult anatomic setting. METHODS The present review provides an in-depth depiction and evaluation of the interventional methodology of the embolization of T2EL in the abdominal aorta with use of ethylene vinyl alcohol copolymer (EVOH). Complicating anatomic conditions are taken into account as well as technical and clinical success rates. RESULTS Using the transarterial approach, there are at least 4 different pathways to access the nidus of a T2EL. CT-guided direct puncture of the aneurysm sac provides an alternative method of high technical success. EVOH with its slow solidification characteristics enables good control to achieve complete filling of the T2EL. During the intervention, however, it remains difficult to meet exactly the embolization endpoint, especially in large T2ELs. CONCLUSION T2EL embolization using EVOH is an effective treatment with low major complication rates when conducted by skilled interventionists with detailed knowledge of diverse complex access routes. KEY POINTS · Many roads lead to Rome to access the nidus of a T2EL including diverse complex transarterial pathways and direct aneurysm sac puncture.. · Ethylene vinyl alcohol co-polymer enables good control for slow filling of the nidus with low risk of major complications.. · Identification of the embolization endpoint remains difficult during the procedure and may result in secondary interventions.. · Successful T2EL embolization requires detailed knowledge of all access routes to the nidus and skilled handling of liquid embolics.. CITATION FORMAT · Nolte-Ernsting C, Mecklenbeck F, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1502-7883.
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Affiliation(s)
- Claus Nolte-Ernsting
- Klinik für Diagnostische und Interventionelle Radiologie, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Frank-Peter Mecklenbeck
- Klinik für Diagnostische und Interventionelle Radiologie, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Alexander Stehr
- Gefäßchirurgische Klinik, Evangelisches Krankenhaus Mülheim an der Ruhr, Germany
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5
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Hicks RM, Vartanian SM, Lehrman ED. Transvenous Type 2 Endoleak Embolization Using Intravascular Ultrasound Guidance via a Left-Sided Inferior Vena Cava. J Vasc Interv Radiol 2021; 32:1395-1398. [PMID: 34033904 DOI: 10.1016/j.jvir.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Robert M Hicks
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Shant M Vartanian
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco
| | - Evan D Lehrman
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco
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6
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Heidemann F, Rohlffs F, Tsilimparis N, Spanos K, Behrendt CA, Eleshra A, Panuccio G, Debus ES, Kölbel T. Transcaval embolization for type II endoleak after endovascular aortic repair of infrarenal, juxtarenal, and type IV thoracoabdominal aortic aneurysm. J Vasc Surg 2021; 74:38-44. [PMID: 33348001 DOI: 10.1016/j.jvs.2020.12.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aims to determine the outcomes of transcaval embolization (TCE) for type II endoleak after infrarenal endovascular aortic repair (EVAR) and fenestrated/branched EVAR (F/BEVAR). METHODS A retrospective single-center cohort study of all consecutive TCE procedures between August 2015 and August 2019 was performed to investigate technical success, in-hospital morbidity, and 30-day mortality as well as clinical success during follow-up. The indication for TCE was an aneurysm sac growth of 5 mm or more owing to a type II endoleak after EVAR for infrarenal or F/BEVAR for juxtarenal and type IV thoracoabdominal aortic aneurysm. RESULTS A total 25 TCE procedures in 24 patients (95.8% male) were included. Technical success was 96.0% (24/25); selective and nonselective TCE were performed in 48% of patients. The in-hospital morbidity and 30-day mortality were 0%. The median follow-up was 23.1 months (interquartile range, 10.9-40.1 months). Freedom from type II endoleak-related reintervention was 84.6% at 12 months. Comparing clinical success after TCE, reintervention was necessary in 16.7% of patients after nonselective and 20% of patients after selective TCE. Regarding TCE after EVAR vs F/BEVAR, reintervention was performed in 12.5% of EVAR and 33.3% of F/BEVAR patients during follow-up. CONCLUSIONS TCE is an acceptable treatment alternative for type II endoleak with aneurysm sac enlargement and can be used after EVAR for infrarenal abdominal aortic aneurysms and F/BEVAR for juxtarenal abdominal aortic aneurysms and type IV thoracoabdominal aortic aneurysms.
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Affiliation(s)
- Franziska Heidemann
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany.
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Kostantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Christian-Alexander Behrendt
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Ahmed Eleshra
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - E Sebastian Debus
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
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7
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Sánchez FSL, González IC, Calvo RS, Fernández PLS. Transcaval Access to the Abdominal Aorta: indications of Interest to Surgeons and a Comprehensive Literature Review. Braz J Cardiovasc Surg 2020; 35:781-788. [PMID: 33118744 PMCID: PMC7598958 DOI: 10.21470/1678-9741-2019-0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.
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Affiliation(s)
- Francisco S Lozano Sánchez
- Hospital Universitario de Salamanca Department of Angiology and Vascular Surgery Salamanca Spain Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ignacio Cruz González
- Hospital Universitario de Salamanca Department of Cardiology Salamanca Spain Department of Cardiology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Roberto Salvador Calvo
- Hospital Universitario de Salamanca Department of Angiology and Vascular Surgery Salamanca Spain Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Pedro Luis Sánchez Fernández
- Hospital Universitario de Salamanca Department of Cardiology Salamanca Spain Department of Cardiology, Hospital Universitario de Salamanca, Salamanca, Spain
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8
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Wee IJY, Syn N, Choong AM. Transcaval approach for endovascular aortic interventions: A systematic review. J Cardiol 2018; 72:369-376. [DOI: 10.1016/j.jjcc.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/17/2018] [Accepted: 04/11/2018] [Indexed: 11/15/2022]
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9
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Daye D, Walker TG. Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management. Cardiovasc Diagn Ther 2018; 8:S138-S156. [PMID: 29850426 DOI: 10.21037/cdt.2017.09.17] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In recent decades, endovascular aneurysm repair or endovascular aortic repair (EVAR) has become an acceptable alternative to open surgery for the treatment of thoracic and abdominal aortic aneurysms and other aortic pathologies such as the acute aortic syndromes (e.g., penetrating aortic ulcer, intramural hematoma, dissection). Available data suggest that endovascular repair is associated with lower perioperative 30-day all-cause mortality as well as a significant reduction in perioperative morbidity when compared to open surgery. Additionally, EVAR leads to decreased blood loss, eliminates the need for cross-clamping the aorta and has shorter recovery periods than traditional surgery. It is currently the preferred mode of treatment of thoracic and abdominal aortic aneurysms in a subset of patients who meet certain anatomic criteria conducive to endovascular repair. The main disadvantage of EVAR procedures is the high rate of post-procedural complications that often require secondary re-intervention. As a result, most authorities recommend lifelong imaging surveillance following repair. Available surveillance modalities include conventional radiography, computed tomography, magnetic resonance angiography, ultrasonography, nuclear imaging and conventional angiography, with computed tomography currently considered to be the gold standard for surveillance by most experts. Following endovascular abdominal aortic aneurysm (AAA) repair, the rate of complications is estimated to range between 16% and 30%. The complication rate is higher following thoracic EVAR (TEVAR) and is estimated to be as high as 38%. Common complications include both those related to the endograft device and systemic complications. Device-related complications include endoleaks, endograft migration or collapse, kinking and/or stenosis of an endograft limb and graft infection. Post-procedural systemic complications include end-organ ischemia, cerebrovascular and cardiovascular events and post-implantation syndrome. Secondary re-interventions are required in approximately 19% to 24% of cases following endovascular abdominal and thoracic aortic aneurysm repair respectively. Typically, most secondary reinterventions involve the use of percutaneous techniques such as placement of cuff extension devices, additional endograft components or stents, enhancement of endograft fixation, treatment of certain endoleaks using various embolization techniques and embolic agents and thrombolysis of occluded endograft components. Less commonly, surgical conversion and/or open surgical modification are required. In this article, we provide an overview of the most common complications that may occur following endovascular repair of thoracic and AAAs. We also summarize the current surveillance recommendations for detecting and evaluating these complications and discuss various current secondary re-intervention approaches that may typically be employed for treatment.
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Affiliation(s)
- Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - T Gregory Walker
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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10
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Massimi TM, Kostun ZW, Woo EY. Transcaval embolization of a type I gutter endoleak after three-vessel chimney endovascular aneurysm repair. J Vasc Surg 2016; 65:1515-1517. [PMID: 27865636 DOI: 10.1016/j.jvs.2016.09.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/22/2016] [Indexed: 11/20/2022]
Abstract
Chimney endovascular aneurysm repair provides an endovascular treatment for complex aortic aneurysms. However, type I gutter endoleaks can complicate this approach and prevent full aneurysm exclusion. Treatment of these leaks can be challenging. We report successful embolization of a type I gutter endoleak after (chimney endovascular aneurysm repair) via a transcaval approach.
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Affiliation(s)
| | | | - Edward Y Woo
- Medstar Heart and Vascular Institute, Washington, DC
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11
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Kajiwara K, Yamagami T, Urashima M, Tomiyoshi H, Kakizawa H, Yoshimatsu R, Ishikawa M, Awai K. Embolization for type 2 endoleak with sac expansion after endovascular repair of abdominal aortic aneurysm: safety and effectiveness. SPRINGERPLUS 2016; 5:262. [PMID: 27006871 PMCID: PMC4775713 DOI: 10.1186/s40064-016-1934-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 02/24/2016] [Indexed: 11/14/2022]
Abstract
To evaluate the safety and outcome of embolization as treatment for persistent type 2 endoleak (T2EL) occurring after abdominal aortic stent graft implantation. This retrospective study included seven consecutive patients (one female, six males, mean age 72 years, range 66–88 years) with T2EL between January 2011 and September 2012. In all, T2EL was associated with an increase more than 5 mm in the aneurysm. The endoleak cavity or feeding artery was embolized with coils and/or n-butyl cyanoacrylate. Clinical success was defined as regression or stabilization of the aneurysm sac irrespective of residual endoleaks on follow-up CT studies. At the time of T2EL intervention, mean aneurysm sac diameter was 63 mm (range 52–72 mm), and mean increase size of aneurysm sac diameter was 7 mm (range 5–13). Mean follow-up period was 6.0 ± 6.2 months (range 3–18 months). Our technical success rate was 100 %. Clinical success was obtained in 5 (71.4 %) of the seven patients. One patient was embolized three times due to sac expansion. T2EL was treated by transarterial embolization in eight procedures, and one procedure was performed by direct puncture embolization. There were no major complications; two procedures elicited minor complications: transient back pain and muscle weakness of the left lower leg. We suggest embolization was safe and effective treatment, a less invasive treatment option comparison to open repair, as one choice to address T2EL.
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Affiliation(s)
- Kenji Kajiwara
- Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Takuji Yamagami
- Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Masaki Urashima
- Diagnostic Radiology, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518 Japan
| | - Hideki Tomiyoshi
- Radiology, Higashihiroshima Medical Center, 513 Saijyou-tyo, Hiroshima, 739-0041 Japan
| | - Hideaki Kakizawa
- Radiology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6, Senda-machi, Naka-ku, Hiroshima, 730-8619 Japan
| | - Rika Yoshimatsu
- Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Masaki Ishikawa
- Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Kazuo Awai
- Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
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Ioannou CV, Kontopodis N, Georgakarakos E, Dalainas I. Commentary: transcaval approach in the management of a type I endoleak associated with the ovation stent-graft system. J Endovasc Ther 2015; 22:431-5. [PMID: 25900724 DOI: 10.1177/1526602815583821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Efstratios Georgakarakos
- Vascular Surgery Unit, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ilias Dalainas
- Vascular Surgery Department, University of Athens, Athens, Greece
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13
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Wolosker N, Varella AYM, Teivelis MP, Mendes CDA, Garcia RG, Pfeferman E. Successful Image-Guided Percutaneous Embolization of a Ruptured Abdominal Aortic Aneurysm Sac due to Type II Endoleak after Endovascular Repair. Ann Vasc Surg 2015; 29:361.e1-4. [DOI: 10.1016/j.avsg.2014.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/09/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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14
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Gandini R, Chiocchi M, Loreni G, Del Giudice C, Morosetti D, Chiaravalloti A, Simonetti G. Treatment of Type II Endoleak After Endovascular Aneurysm Repair: The Role of Selective vs. Nonselective Transcaval Embolization. J Endovasc Ther 2014; 21:714-22. [DOI: 10.1583/14-4571mr.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Toya N, Kanaoka Y, Ohki T. Secondary interventions following endovascular repair of abdominal aortic aneurysm. Gen Thorac Cardiovasc Surg 2013; 62:87-94. [DOI: 10.1007/s11748-013-0333-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Indexed: 12/11/2022]
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16
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Karaman K, Dokdok AM, Karadeniz O. CT- and Fluoroscopy-Guided Percutaneous Transabdominal Embolization of Type II Endoleak. Eurasian J Med 2013; 45:132-4. [PMID: 25610266 DOI: 10.5152/eajm.2013.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/02/2013] [Indexed: 11/22/2022] Open
Abstract
We report a case of a 79-year-old male patient who was treated 3 years previously at another hospital for an abdominal aortic aneurysm with a maximal diameter of 80 mm. After the treatment control period, computed tomography imaging revealed a type II endoleak and no progression in the size of the aneurysm sac. Selective injection of the superior mesenteric artery revealed that the endoleak was filled by the inferior mesenteric artery via the marginal artery. However, it was not possible to access using retrograde catheterization. We decided to treat the type II endoleak percutaneously. Embolization was performed at the tomography table using fluoroscopy with a mobile C-arm, and the puncture was performed transabdominally because there was no access to the sac via a translumbar approach. Under fluoroscopic guidance, various diameter/length coils were deployed. Follow-up computed tomography scans confirmed the collapsed aneurysm sac. When other conventional endovascular methods have failed, percutaneous transabdominal treatment of a type II endoleak with sac enlargement offers an alternative treatment method.
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Affiliation(s)
- Kutlay Karaman
- Department of Radiology, Anadolu Medical Center, Kocaeli, Turkey
| | - A Murat Dokdok
- Department of Radiology, Anadolu Medical Center, Kocaeli, Turkey
| | - Oktay Karadeniz
- Department of Radiology, Anadolu Medical Center, Kocaeli, Turkey
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Transarterial Embolization of Type II Endoleaks after EVAR: The Role of Ethylene Vinyl Alcohol Copolymer (Onyx). Cardiovasc Intervent Radiol 2013; 36:1288-95. [DOI: 10.1007/s00270-013-0567-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 12/30/2012] [Indexed: 11/25/2022]
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Midulla M, Perini P, Sundareyan R, Lazguet Y, Dehaene A, Goyault G, Martinelli T, Haulon S. Transcatheter Transcaval Embolization of a Type II Endoleak After EVAR Using a Transseptal Needle-Sheath System. Vasc Endovascular Surg 2012; 46:410-3. [DOI: 10.1177/1538574412448683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. The purpose of this study is to present an alternative technique for management of a type II endoleak associated with aneurysm sac enlargement. Technique. We report the use of a transseptal needle-sheath system for a transcatheter transcaval embolization (TTE) in a 3-staged treatment of a persistent type II endoleak after abdominal EVAR. Inferior vena cava is cannulated through a femoral venous access, and aneurysmal sac access is gained with a puncture through the walls of the 2 vessels at the site where the vein is adjacent to the aneurysm. The whole system (sheath–dilator–needle) is then advanced across the vascular walls into the aortic sac. Thus, embolization with glue is performed. Conclusion. The TTE using a transseptal needle-sheath system demonstrated to be feasible and effective to treat a persistent type II endoleak after failure of 2 attempts of transarterial embolization of the feeding vessels.
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Affiliation(s)
- Marco Midulla
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Paolo Perini
- Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France
| | - Ramanivas Sundareyan
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Younes Lazguet
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Aurelie Dehaene
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Gilles Goyault
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Thomas Martinelli
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Stéphan Haulon
- Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France
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Choi SY, Won JY, Lee DY, Choi D, Shim WH, Lee KH. Percutaneous transabdominal approach for the treatment of endoleaks after endovascular repair of infrarenal abdominal aortic aneurysm. Korean J Radiol 2009; 11:107-14. [PMID: 20046501 PMCID: PMC2799639 DOI: 10.3348/kjr.2010.11.1.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 10/30/2009] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Materials and Methods Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months) Results Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. Conclusion The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.
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Affiliation(s)
- Sun Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, University of Yonsei, College of Medicine, Seoul 120-752, Korea
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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]
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Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Intervent Radiol 2009; 33:278-84. [PMID: 19688365 DOI: 10.1007/s00270-009-9685-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 07/15/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to report our experience in treating type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms. Two hundred eighteen patients underwent EVAR with a Zenith stent-graft from January 2000 to December 2005. During a follow-up period of 4.5 + or - 2.3 years, solely type II endoleak was detected in 47 patients (22%), and 14 of them underwent secondary interventions to correct this condition. Ten patients had transarterial embolization, and four patients had translumbar/transabdominal embolization. The embolization materials used were coils, thrombin, gelatin, Onyx (ethylene-vinyl alcohol copolymer), and glue. Disappearance of the endoleak without enlargement of the aneurysm sac after the first secondary intervention was achieved in only five of these patients (5/13). One patient without surveillance imaging was excluded from analyses of clinical success. After additional interventions in four patients and the spontaneous disappearance of type II endoleak in two patients, overall clinical success was achieved in eight patients (8/12). One patient did not have surveillance imaging after the second secondary intervention. Clinical success after the first secondary intervention was achieved in two patients (2/9) in the transarterial embolization group and three patients (3/4) in the translumbar embolization group. The results of secondary interventions for type II endoleak are unsatisfactory. Although the small number of patients included in this study prevents reliable comparisons between groups, the results seem to favor direct translumbar embolization in comparison to transarterial embolization.
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Endofugas tipo II tras tratamiento endovascular de los aneurismas de aorta abdominal: incidencia, factores predisponentes, pruebas diagnósticas, indicaciones y alternativas terapéuticas. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)14003-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Laganà D, Mangini M, Fontana F, Nicotera P, Carrafiello G, Fugazzola C. Percutaneous Treatment of Sac Rupture in Abdominal Aortic Aneurysms Previously Excluded with Endovascular Repair (EVAR). Cardiovasc Intervent Radiol 2008; 32:178-83. [DOI: 10.1007/s00270-008-9358-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 03/24/2008] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
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Mansueto G, Cenzi D, Scuro A, Gottin L, Griso A, Gumbs AA, Mucelli RP. Treatment of type II endoleak with a transcatheter transcaval approach: Results at 1-year follow-up. J Vasc Surg 2007; 45:1120-7. [PMID: 17543674 DOI: 10.1016/j.jvs.2007.01.063] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 01/25/2007] [Indexed: 11/27/2022]
Abstract
PURPOSE This study assessed the feasibility and mid-term outcomes in the treatment of type II endoleak using transcatheter transcaval embolization (TTE). METHODS During an 8-month period, 12 patients underwent TTE. After direct transcaval puncture of the aneurysm sac, embolization was performed by injecting thrombin and placing coils. Systemic and intrasac pressures were recorded throughout the entire procedure. Computed tomography (CT) scans were performed at 24 hours, 30 days, 6 months, and 1 year after TTE to evaluate endoleaks and changes in sac diameter. Technical success was defined as the feasibility of the procedure; clinical success was defined as no evidence of leaks during the follow-up evaluation. RESULTS TTE was feasible in 11 of 12 patients (technical success 92%). The mean systemic pressure was 117 mm Hg. The mean intrasac pressure before embolization was 75 mm Hg (range, 39 to 125 mm Hg), 16.5 mm Hg (range, 7 to 40 mm Hg) in 10 patients after embolization, and it increased in one patient. CT scans at 24 hours showed stable contrast medium inside the sac in 10 patients. Only minor complications were observed during follow-up. At the 1-year follow-up, no recurrence of leaks was noted, and sac diameter was reduced in 10 of 11 patients. As a result, TTE clinical success was obtained in 10 (83%) of 12 patients. CONCLUSION TTE appears to be a feasible technique for the complete exclusion of type II endoleaks. Technical and clinical successes are comparable with other treatment strategies, and TTE should be considered an alternative to direct translumbar puncture of the aneurysm sac.
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Affiliation(s)
- Giancarlo Mansueto
- Department of Morphological and Biomedical Sciences-Radiology Institute, Intensive Care Unit, University Hospital GB Rossi, Verona, Italy.
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