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Koudounas G, Giannopoulos S, Charisis N, Labropoulos N. Understanding Type II Endoleak: A Harmless Imaging Finding or a Silent Threat? J Clin Med 2024; 13:4250. [PMID: 39064290 PMCID: PMC11277561 DOI: 10.3390/jcm13144250] [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: 06/18/2024] [Revised: 07/06/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Type II endoleak (T2EL) represents a challenging clinical entity following endovascular abdominal aortic aneurysm repair (EVAR). Although several studies have suggested that T2ELs are related to an increased risk of aneurysm sac growth and subsequent rupture, the exact role that T2ELs play in long-term outcomes remains debatable. Understanding the pathophysiology, diagnostic modalities, and management options of T2ELs is important for patients' safety and proper resource utilization. While conservative management may be suitable for asymptomatic patients with a stable aneurysm size, interventional approaches, including transarterial embolization, direct sac puncture embolization and open conversion have been described for patients with persistent T2EL associated with sac expansion. However, more research is needed to better determine the clinical benefit of such interventions. A thorough evaluation of all endoleak types before T2EL treatment would be reasonable for patients with T2ELs associated with sac expansion. Further studies are needed to refine treatment strategies aimed at minimizing T2EL-related complications. Collaborative efforts among vascular specialists, radiologists, and researchers are of paramount importance to address this ongoing clinical challenge.
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Affiliation(s)
- Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Aristotle University Medical School, Hippokratio Hospital, 54642 Thessaloniki, Greece;
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY 11794, USA;
| | - Nektarios Charisis
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA;
| | - Nicos Labropoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY 11794, USA;
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Yamanaka K, Kawabata R, Hamaguchi M, Chomei S, Inoue T, Hasegawa S, Tsujimoto T, Koda Y, Miyahara S, Takahashi H, Okada T, Yamaguchi M, Okada K. Open Conversion with Explantation of Stent Grafts After Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm. Ann Vasc Surg 2024; 104:38-47. [PMID: 37536432 DOI: 10.1016/j.avsg.2023.07.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Although endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is widely used worldwide, the fact that it is associated with increased rates of reintervention has been considered a problem. This study aimed to analyze the outcomes of primary open AAA repair and open conversion with explantation of stent grafts after EVAR. METHODS In this retrospective study, we enrolled 1,120 patients (open repair, n = 664; EVAR, n = 456) who underwent AAA repair at Kobe University from 1999 to 2019. Of the 664 patients who underwent open repair, 121 (patients who underwent primary open repair (POR) as a concomitant procedure and patients with ruptured AAA) were excluded from the study. The outcomes of POR were compared with those of open conversion with explantation of stent grafts. RESULTS Of the 543 patients who underwent open repair, 513 underwent POR and 30 underwent open conversion with explantation of stent grafts. The operation time for POR was significantly less than that for open conversion with explantation. During surgery, patients who underwent open conversion with explantation required significantly more transfusions of red cell concentrate, fresh frozen plasma, and platelet concentrate than those who underwent POR. Overall, 30 patients who underwent open conversion with explantation required a total of 48 reinterventions before surgery. Hospital mortality rates were 0.7% and 0% in the POR and open conversion with explantation groups, respectively (P = 0.62). Although overall survival at 5 years in the POR group was significantly better than that in the open conversion with explantation group (89.3 ± 1.7% vs. 79.5 ± 9.6%; P = 0.01), there were no significant differences between the 2 groups regarding the freedom from aortic event (hospital death, reintervention, and aortic death). According to the multivariate analysis, open conversion with explantation was not an independent risk factor for late death. There were 20 patients who were hesitant to undergo OCE, although we recommended OCE. In a subgroup analysis, the overall mean cost borne by patients who underwent EVAR was approximately 2.3 times higher compared with that borne by patients who underwent POR. CONCLUSIONS Although demanding, both early and long-term outcomes of OCE have been favorable in our present study. OCE is highly recommended in patients with persistent sac enlargement after EVAR.
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Affiliation(s)
- Katsuhiro Yamanaka
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Ryo Kawabata
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Mari Hamaguchi
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Shunya Chomei
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Taishi Inoue
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Shota Hasegawa
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Takanori Tsujimoto
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Yojiro Koda
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Shunsuke Miyahara
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Hiroaki Takahashi
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan
| | - Takuya Okada
- The Department of Radiology, University of Kobe, Kobe, Japan
| | | | - Kenji Okada
- Division of Cardiovascular Surgery, The Department of Surgery, University of Kobe, Kobe, Japan.
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Moosavi B, Kaitoukov Y, Khatchikian A, Bayne JP, Constantin A, Camlioglu E. Direct sac puncture versus transarterial embolization of type II endoleaks after endovascular abdominal aortic aneurysm repair: Comparison of outcomes. Vascular 2024; 32:499-506. [PMID: 36753720 PMCID: PMC11129519 DOI: 10.1177/17085381231156661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE Type 2 endoleak (T2EL) is the most common type of endoleak after endovascular abdominal aortic aneurysm repair (EVAR), and increases the risk of aneurysm sac rupture if it persists beyond 6 months. The purpose of this study is to compare the efficacy and safety of direct sac puncture versus transarterial embolization of T2ELs. METHODS Retrospective review of 42 consecutive T2EL embolization procedures, 19 by DSP and 23 by transarterial technique, between January 2015 and December 2020. Primary outcome was aneurysm sac stability and resolution of endoleak at follow-up imaging. Adverse events (AE) were classified based on the Society of Interventional Radiology (SIR) practice guidelines. RESULTS Technical success was 94.7% (18/19) in the DSP group and 86.9% (20/23) in the transarterial group (p = 0.32 (-0.77-0.25)). Treatment efficacy was evaluated in 16 patients in the DSP group and 18 patients in the transarterial group who had follow-up imaging ≥6 months after embolization. Mean imaging follow-up was 17.1 ± 11.2 (range, 6-41) months in the DSP group and 26.5 ± 15.4 (range, 6-48) months in the transarterial group (p = 0.06, -19.24-0.37). Treatment efficacy was 75% (12/16) in the DSP group and 33.3% (6/18) in the transarterial group (p = 0.02, 95% CI, 0.09-0.97). There was no procedure-related mortality. Moderate-severe AE occurred in 15.7% (3/19) in the DSP group and 8.7% (2/23) in the transarterial group (p = 0.44, -0.12-0.26). CONCLUSION In this study, DSP embolization of T2EL was equally safe and more effective than transarterial embolization in achieving aneurysm sac stability and resolution of endoleak.
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Affiliation(s)
- Bardia Moosavi
- Department of Radiology, McGill University, Montreal, QC, Canada
| | - Youri Kaitoukov
- Department of Radiology, McGill University, Montreal, QC, Canada
| | - Aline Khatchikian
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - Jason P Bayne
- Department of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada
| | | | - Errol Camlioglu
- Department of Radiology, Jewish General Hospital, QC, Canada
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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.
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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.)
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Chun JY, de Haan M, Maleux G, Osman A, Cannavale A, Morgan R. CIRSE Standards of Practice on Management of Endoleaks Following Endovascular Aneurysm Repair. Cardiovasc Intervent Radiol 2024; 47:161-176. [PMID: 38216742 PMCID: PMC10844414 DOI: 10.1007/s00270-023-03629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/19/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Endoleaks represent the most common complication after EVAR. Some types are associated with ongoing risk of aneurysm rupture and necessitate long-term surveillance and secondary interventions. PURPOSE This document, as with all CIRSE Standards of Practice documents, will recommend a reasonable approach to best practices of managing endoleaks. This will include imaging diagnosis, surveillance, indications for intervention, endovascular treatments and their outcomes. Our purpose is to provide recommendations based on up-to-date evidence, updating the guidelines previously published on this topic in 2013. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of clinicians with internationally recognised expertise in endoleak management. The writing group reviewed the existing literature performing a pragmatic evidence search using PubMed to select publications in English and relating to human subjects up to 2023. The final recommendations were formulated through consensus. RESULTS Endoleaks may compromise durability of the aortic repair, and long-term imaging surveillance is necessary for early detection and correct classification to guide potential re-intervention. The majority of endoleaks that require treatment can be managed using endovascular techniques. This Standards of Practice document provides up-to-date recommendations for the safe management of endoleaks.
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Affiliation(s)
- Joo-Young Chun
- St George's University Hospitals NHS Foundation Trust, London, UK.
- St George's University of London, London, UK.
| | - Michiel de Haan
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Asaad Osman
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Robert Morgan
- St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
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Massmann A, Fries P, Shayesteh-Kheslat R, Buecker A, Berg P, Frenzel F. Feasibility of aortic aneurysm sac embolization using a novel shape memory polymer embolic device. Eur Radiol Exp 2023; 7:12. [PMID: 37009937 PMCID: PMC10068687 DOI: 10.1186/s41747-023-00328-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/30/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND We investigated the feasibility of aneurysm sac embolization using a novel self-expanding porous shape memory polymer (SMP) device during endovascular aortic abdominal or thoracic aneurysm repair (EVAR). METHODS Retrospective analysis of consecutive patients treated at 2 centers in Germany. Patients were treated from January 2019 to July 2021 with follow-up at 7 days and 3, 6, and 12 months. Aneurysm sacs were implanted with SMP devices immediately following endograft placement during the same procedure. Primary endpoint was technically successful SMP-device deployment into the aneurysm sac outside the endograft. Secondary endpoints were changes in aneurysm volume and associated complications (e.g., endoleaks). RESULTS We included 18 patients (16 males), aged 72 ± 9 years, achieving 100% technical success. Mean preprocedure aortic aneurysm sac volume was 195 ± 117 mL with a perfused aneurysm volume of 97 ± 60 mL. A mean of 24 ± 12 SMP devices per patient were used (range 5-45, corresponding to 6.25-56.25 mL expanded embolic material volume). All evaluable patients exhibited sac regression except 2 patients yet to reach 3-month follow-up. At mean 11 ± 7 months (range 3-24), change in aneurysm volume from baseline was -30 ± 21 mL (p < 0.001). In 8 patients, aneurysm regression was observed despite type 2 endoleaks in 6 and type 1A endoleaks in 2, none of them requiring further intervention to date. No morbidity or mortality related to this treatment occurred. CONCLUSIONS SMP devices for aortic aneurysm sac embolization during endovascular repair appear feasible and safe in this small case series. Prospective studies are needed. KEY POINTS • Shape memory polymer is a novel, self-expanding, porous, and radiolucent embolic device material. • Aortic aneurysm sacs were treated with polymer devices immediately following endograft placement. • Aortic aneurysm sac regression was observed in all patients with over 3-month follow-up. • Aortic aneurysm sac regression was observed even in the presence of endoleaks.
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Affiliation(s)
- Alexander Massmann
- Radiology and Nuclear Medicine, Bosch Health Campus, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Germany.
| | - Peter Fries
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Roushanak Shayesteh-Kheslat
- Clinic for General, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Arno Buecker
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Patrick Berg
- Clinic for Vascular Surgery, Katholisches Karl-Leisner-Klinikum, Kevelaer, Germany
| | - Felix Frenzel
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
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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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Ko G, Choi JW, Lee N, Kim D, Hyeon T, Kim HC. Recent progress in liquid embolic agents. Biomaterials 2022; 287:121634. [PMID: 35716628 DOI: 10.1016/j.biomaterials.2022.121634] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022]
Abstract
Vascular embolization is a non-surgical procedure used to treat diseases or morbid conditions related to blood vessels, such as bleeding, arteriovenous malformation, aneurysm, and hypervascular tumors, through the intentional occlusion of blood vessels. Among various types of embolic agents that have been applied, liquid embolic agents are gaining an increasing amount of attention owing to their advantages in distal infiltration into regions where solid embolic agents cannot reach, enabling more extensive embolization. Meanwhile, recent advances in biomaterials and technologies have also contributed to the development of novel liquid embolic agents that can resolve the challenges faced while using the existing embolic materials. In this review, we briefly summarize the clinically used embolic agents and their applications, and then present selected research results that overcome the limitations of the embolic agents in use. Through this review, we suggest the required properties of liquid embolic agents that ensure efficacy, which can replace the existing agents, providing directions for the future development in this field.
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Affiliation(s)
- Giho Ko
- Center for Nanoparticle Research, Institute for Basic Spegcience (IBS), Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Nohyun Lee
- School of Advanced Materials Engineering, Kookmin University, Seoul 02707, Republic of Korea
| | - Dokyoon Kim
- Department of Bionano Engineering and Bionanotechnology, Hanyang University, Ansan 15588, Republic of Korea.
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Spegcience (IBS), Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
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Systematic review on transcaval embolization for type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2022; 76:282-291.e2. [DOI: 10.1016/j.jvs.2022.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
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Cruz J, McGillen K, Pryor W, Esslinger D, Shin B. Novel use of contrast-enhanced ultrasound in the pretreatment planning prior to endovascular repair of endoleak after endovascular aortic aneurysm repair in a patient with chronic renal insufficiency: A case report and literature review. J Med Ultrasound 2022; 30:54-58. [PMID: 35465604 PMCID: PMC9030361 DOI: 10.4103/jmu.jmu_173_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/17/2021] [Accepted: 03/02/2021] [Indexed: 11/04/2022] Open
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Burke CT, Yu H. How I Do It: Computed Tomography-Guided Modified Translumbar Embolization of Type 2 Endoleak. Semin Intervent Radiol 2021; 38:576-580. [PMID: 34853504 DOI: 10.1055/s-0041-1736656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Charles T Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Churchill D, Motaganahalli R, LaRoche T, Ramkaransingh J. A novel approach for treating type II endoleaks utilizing contrast-enhanced ultrasound. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:581-585. [PMID: 34504986 PMCID: PMC8411011 DOI: 10.1016/j.jvscit.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/29/2021] [Indexed: 12/04/2022]
Abstract
Endoleaks are a frequent and well-known complication after endovascular repair of aortic aneurysms. An endoleak can lead to increased intrasac pressure, sac enlargement, and potential aneurysm rupture. Type II endoleaks result from retrograde filling of aortic branch vessels and can be treated with surgical, endovascular, or direct percutaneous approaches. Direct percutaneous treatment typically involves embolization of the perfused endoleak cavity typically using a translumbar approach with fluoroscopic guidance. We illustrate a novel image-guided approach for percutaneous transabdominal endoleak treatment using contrast-enhanced ultrasound in combination with fluoroscopy.
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Affiliation(s)
- Dennis Churchill
- Division of Interventional Radiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind
| | - Raghu Motaganahalli
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
- Correspondence: Raghu Motaganahalli, MD, Department of Surgery, Division of Vascular Surgery, Indiana University School of Medicine, 1801 N Senate Blvd, MPC-2 Ste 3500, Indianapolis, IN 46202
| | - Thomas LaRoche
- Division of Interventional Radiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind
- Division of Interventional Radiology, Department of Radiology, Richard L. Roudebush VA Medical Center, Indianapolis, Ind
| | - Jeffrey Ramkaransingh
- Division of Interventional Radiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind
- Division of Interventional Radiology, Department of Radiology, Richard L. Roudebush VA Medical Center, Indianapolis, Ind
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Contrella BN, Wilkins LR, Sheeran DP, Khaja MS, Angle JF. Predictive Value of Preprocedural Computed Tomography Angiography for the Technical Success of Transarterial Embolization of Type II Endoleaks Arising from the Lumbar Arteries. J Vasc Interv Radiol 2021; 32:1016-1021. [PMID: 33823275 DOI: 10.1016/j.jvir.2021.03.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the ability of preprocedural computed tomography angiography (CTA) to predict the technical success of embolization of type II endoleak arising from a lumbar artery after endovascular aortic repair (EVAR). MATERIALS AND METHODS All patients at a single academic institution who underwent angiography with possible embolization for a post-EVAR lumbar-supplied type II endoleak from 2009 to 2018 were retrospectively reviewed. Patients who did not undergo CTA before the procedure were excluded. CTAs were reviewed for the ability to trace the entire course of a feeding vessel from the internal iliac artery (IIA) to the lumbar artery at the site of the endoleak. Procedural imaging was reviewed for technical success, defined as the catheterization and embolization of the aneurysm sac through a lumbar artery. RESULTS Fifty-seven angiograms with a type II endoleak and suspected feeding lumbar artery were identified. On CTA acquired before the procedure, the arterial path supplying this lumbar artery could be traced from the IIA to the aneurysm sac in 18 (32%) patients. Embolization was technically successful in 16 of these 18 (89%) procedures compared with 10 of 39 (26%) procedures in which the supplying artery could not be traced using CTA (P < .001). CONCLUSIONS A potential catheter path from the IIA through the iliolumbar and lumbar arteries to the aneurysm sac can be traced on preprocedural CTA in the minority of lumbar-supplied type II endoleaks. The ability to trace these inflow vessels may predict technical success during embolization. The low rate of technical success when the feeding vessel could not be traced using CTA suggests that these patients should be considered for percutaneous or transcaval sac puncture.
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Affiliation(s)
- Benjamin N Contrella
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA.
| | - Luke R Wilkins
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - Daniel P Sheeran
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - Minhaj S Khaja
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - John F Angle
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
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Computed Tomography Angiography Prediction of Successful Trasnscatheter Embolization for Type II Endoleak of Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Interv Radiol 2021; 32:1011-1015.e1. [PMID: 33831561 DOI: 10.1016/j.jvir.2021.03.546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the utility of computed tomography (CT) angiography before transarterial embolization (TAE) in predicting TAE's technical success for type II endoleaks (T2ELs). MATERIALS AND METHODS Fifty-eight patients (mean age, 74.4 years; range, 46-89 years) who underwent attempted TAE for T2EL from July 2014 to August 2019 and underwent CT angiography before the procedure were included. Each CT angiography result was assessed for a feeding artery that was traceable over its entire course from either the superior mesenteric artery or the internal iliac artery to the endoleak cavity. TAE was performed using coils and was considered technically successful if embolization of the endoleak cavity and feeding artery was performed. The technical success rates were compared between patients with and without traceable feeding arteries. RESULTS A fully traceable feeding artery supplying 75% (44/59) of endoleaks in the cohort was identified. TAE was technically successful in 95% (42/44) of these cases but only in 13% (2/15) of the cases without a fully traceable feeding artery (P < .001). When the inferior mesenteric artery was the feeding artery, it was always fully traceable, and TAE was technically successful in 100% (33/33) of the cases. When a lumbar artery was the feeding artery, it was fully traceable in only 42% (11/26) of the cases. When the lumbar artery was not fully traceable, TAE was technically successful in only 13% (2/15) of the cases. CONCLUSIONS The traceability of a feeding artery over its entire course to an endoleak cavity using CT angiography was associated with TAE's technical success. Lumbar feeding arteries were less likely to be fully traceable. TAE's high failure rate when the feeding artery was not fully traceable suggests that translumbar embolization can be considered as an initial approach for theses patients.
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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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Ameli-Renani S, Pavlidis V, Morgan RA. Secondary Endoleak Management Following TEVAR and EVAR. Cardiovasc Intervent Radiol 2020; 43:1839-1854. [PMID: 32778905 PMCID: PMC7649162 DOI: 10.1007/s00270-020-02572-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/22/2020] [Indexed: 11/01/2022]
Abstract
Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types.
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Affiliation(s)
- Seyed Ameli-Renani
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Vyzantios Pavlidis
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Robert A Morgan
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK.
- Vascular & Cardiac Surgery Research Centre, St George's University of London, Cranmer Terrace, London, SW17 ORE, UK.
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Abstract
INTRODUCTION The past 25 years have been witness to a revolution in how vascular care is delivered. The majority of arterial and venous interventions have converted from open surgery to minimally invasive percutaneous endovascular procedures. METHODS This surgical innovations symposium article reviews current endovascular therapy in multiple vascular beds with a primary focus on carotid artery occlusive disease, aortic pathologies, and lower extremity arterial occlusive disease. Mesenteric arterial occlusive disease and lower extremity venous endovascular therapies are also briefly discussed. Indications for intervention, treatment examples and outcomes analysis are presented. While not reviewed in this article, endovascular therapy has also become first line in the treatment of coronary artery disease, chronic mesenteric arterial occlusive disease, superficial venous reflux, central vein occlusion, and acute venous thrombus intervention when indicated. CONCLUSION Endovascular therapies are used in all vascular beds to treat the full spectrum of vascular pathologies. Aneurysm disease, atherosclerotic arterial occlusive disease, acute arterial and venous thrombosis, ongoing hemorrhage, and venous reflux are among the issues which can be addressed by endovascular means. The minimally invasive nature of endovascular treatments in what is largely a very co-morbid patient cohort is an attractive method of avoiding major procedural related morbidity and mortality.
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Affiliation(s)
- Matthew Blecha
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, EMS Building 110, Room 3213, Maywood, IL, 60153, USA.
| | - Vivian Gahtan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, EMS Building 110, Room 3213, Maywood, IL, 60153, USA
- Edward Hines Jr VA Hospital, Hines, IL, USA
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18
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Wong GR, Yu H, Isaacson AJ. Comparison of Cost and Efficacy of Trufill® vs Histoacryl® n-Butyl Cyanoacrylate for Translumbar Type 2 Endoleak Embolization. Vasc Endovascular Surg 2020; 55:152-157. [PMID: 33208033 DOI: 10.1177/1538574420973821] [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: 11/15/2022]
Abstract
PURPOSE The study aimed to compare the cost and efficacy of translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl® n-BCA liquid embolic. METHOD AND MATERIALS This was a retrospective review of patients who had translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl®. Patients were included if they underwent a technically successful type 2 endoleak repair via a translumbar approach with Trufill® or Histoacryl® n-BCA. A multivariable analysis was performed with the primary clinical outcome of percent change in aneurysm diameter per month compared. Procedure cost was calculated based on typical materials used. RESULTS 20 Trufill® and 14 Histoacryl® patients were included. The mean procedure cost was higher for Trufill® ($5,757.30 vs. $1,586.09, p ≤ 0.001). There was no significant difference between Trufill® or Histoacryl® patients for age at first embolization, gender, total number of embolizations, number of feeding branches, aneurysm sac size prior to embolization, or residual endoleak at first follow-up. Trufill® patients had more coils used (12.0 vs. 4.3, p = 0.0007), less glue used (0.9 vs. 2.1 mL, p < 0.001), longer follow-up duration (33.5 vs. 13.2 months, p = 0.002), more follow-up CT angiograms (CTA) (3.7 vs. 1.9, p = 0.01), and larger excluded aneurysm sac size at most recent CTA (7.1 cm vs. 5.9 cm, p = 0.04). Percent change in sac diameter per month was not significantly different between Trufill® and Histoacryl® (0.21% vs. -0.25%/month, p = 0.06, respectively). There were no complications. CONCLUSION Use of Histoacryl® over Trufill® n-BCA resulted in significantly less procedural cost while maintaining safety and efficacy.
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Affiliation(s)
- George Raymond Wong
- Division of Vascular and Interventional Radiology, Department of Radiology, 6797University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, 6797University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ari J Isaacson
- Division of Vascular and Interventional Radiology, Department of Radiology, 6797University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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19
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Transgraft embolization by using long needle for the treatment of type II endoleaks after endovascular abdominal aortic repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:590-594. [PMID: 33145470 PMCID: PMC7593341 DOI: 10.1016/j.jvscit.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022]
Abstract
We used a long custom needle (LCN) to improve transgraft embolization (TGE) in 10 reported cases that underwent TGE with LCN for type II endoleak (T2E) treatment after endovascular abdominal aortic aneurysm repair. TGE was performed with a LCN enabling the usage of microcatheter and embolization coils in 10 cases with T2E after endovascular abdominal aortic aneurysm repair. Embolization was successfully achieved in the nidus in all 10 cases. The aneurysmal sac diameter significantly decreased by TGE, and none of the 7 of 10 cases exhibited recurrence of sac expansion or T2E throughout the 2-year follow-up period.
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20
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Abstract
Type 2 endoleaks are the most common endoleak type following endovascular aneurysm repair. The natural history of these endoleaks can vary, with some demonstrating a self-limited or indolent course, while others can contribute to aneurysm sac enlargement and rupture. A variety of embolization techniques, including transarterial catheterization and direct sac puncture techniques, have been developed for the treatment of type 2 endoleaks. In this article, the authors review the indications, techniques, and outcomes of current treatment strategies for type 2 endoleaks.
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Affiliation(s)
- James X Chen
- Division of Vascular and Interventional Radiology Specialists of Charlotte Radiology, Charlotte, North Carolina
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Gonzalez-Urquijo M, Lozano-Balderas G, Fabiani MA. Type II Endoleaks After EVAR: A Literature Review of Current Concepts. Vasc Endovascular Surg 2020; 54:718-724. [PMID: 32744153 DOI: 10.1177/1538574420945448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endoleak is the most frequent complication following endovascular aneurysm repair, which is not present in the surgical counterpart. The most frequent type of endoleak corresponds to type II, and its natural history remains poorly understood. Therefore, their treatment continues to be a topic of debate. The vast majority of the studies found in the literature are of a retrospective nature, and there are no prospective studies comparing intervention versus a conservative approach. Future studies should aim to compare not only different approaches to resolve type II endoleak but also when should be the right time to treat them, with the primary purpose of avoiding sac rupture. The objective of this review is to provide the reader with a literature overview about type II endoleaks to help in the decision-making process on this topic.
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Affiliation(s)
| | - Gerardo Lozano-Balderas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
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22
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Salaskar AL, Razjouyan F, Cho AL, Sood RR, Akman A, Scher D, Venbrux AC, Sarin SN. Single institutional experience of peripheral applications of a liquid embolic agent: Ethylene Vinyl Alcohol Copolymer. CVIR Endovasc 2020; 3:38. [PMID: 32743749 PMCID: PMC7396416 DOI: 10.1186/s42155-020-00117-2] [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] [Received: 11/23/2019] [Accepted: 04/03/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of ethylene vinyl alcohol (EVOH) copolymer for the treatment of a variety of peripheral vascular pathologies. RESULTS Between October 2010 and October 2017, 43 patients who underwent total 54 EVOH embolization procedures for the treatment of peripheral vascular pathologies were included. The cases which involved the use of EVOH for the treatment of nonvascular, neurologic, ophthalmologic, otolaryngologic or head-neck pathologies were excluded. The demographic data, technical and clinical success rates, and procedure-related details and complications were obtained. The most common indications for EVOH embolization were type II endoleaks (n = 18) and peripheral arteriovenous malformations (n = 14). The majority of cases (62.5%) used EVOH without any adjunct embolic material. The results of this study showed 100% technical success rates and 89% clinical success rates. No events of nontarget embolization or other procedure-related complications were noted. The mortality & morbidity rates were 0%. The loss to follow up rate was 16% (9 /54). The mean follow-up period was 134 days (range, 30 to 522 days). CONCLUSION The single institutional experience supports the safety and efficacy of EVOH embolization in the treatment of various peripheral vascular conditions.
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Affiliation(s)
- Abhijit L Salaskar
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA.
| | - Faezeh Razjouyan
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Alexander L Cho
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Rishi R Sood
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Andrew Akman
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Daniel Scher
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Anthony C Venbrux
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Shawn N Sarin
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
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23
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Thomas WR, Karkhanis S, Hopkins J, Duddy M. Translumbar Embolization of Type II Endoleaks: 12 Years of Experience at a Regional Vascular Centre. Vasc Endovascular Surg 2020; 54:389-394. [DOI: 10.1177/1538574420918972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: The management of persistent type II endoleaks (T2E) is often problematic for the endovascular specialist, with a lack of clear evidence for the best approach for embolization. The aim of this study was to evaluate the safety and efficacy of translumbar embolization (TLE) for T2E following endovascular aneurysm repair (EVAR). Methods: This retrospective review included 27 embolizations performed on 23 patients with a median age of 78 (range 67-94 years; male: female 15:9), during the period September 2006 to July 2018. Primary outcome was freedom from aneurysm sac growth defined as <2 mm sac diameter increase on subsequent computed tomography. Results: The initial technical success rate was 100%, with complete “on table” embolization of the T2E on fluoroscopy; however, 4 (15%) patients needed repeat TLE due to persistent endoleak identified on follow-up computed tomography or because of further sac expansion. Satisfactory stasis was achieved in these 4 cases following a second embolization. The mean volume of embolic injected was 7.4 mL per case. Feeding vessels were identified on angiography in all cases; the nidus was supplied by lumbar branches in 21 cases, by the inferior mesenteric artery in 1 case and by both in a further 5 cases. Freedom from aneurysm sac growth (defined as < 2 mm) following 1 or 2 separate TLE was achieved in 18 (78%) and 20 (86%) patients, respectively. The major complication rate was <5% with one case of psoas abscess presenting 7 months following embolization; there were 2 minor complications in the form of intraprocedural transient abdominal pain. Conclusion: The translumbar approach is a safe and effective technique to treat T2E, as evidenced by the low complication and reintervention rate.
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Affiliation(s)
- Wiliam Rhodri Thomas
- Department of Interventional Radiology, University Hospital, Cardiff, United Kingdom
| | - Salil Karkhanis
- Department of Interventional Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jonathan Hopkins
- Department of Interventional Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Martin Duddy
- Department of Interventional Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Guo Q, Zhao J, Ma Y, Huang B, Yuan D, Yang Y, Du X. A meta-analysis of translumbar embolization versus transarterial embolization for type II endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2020; 71:1029-1034.e1. [DOI: 10.1016/j.jvs.2019.05.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/25/2019] [Indexed: 10/25/2022]
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Immediate and 1-year success rate of type 2 endoleak treatment using three-dimensional image fusion guidance. Diagn Interv Imaging 2020; 101:589-598. [PMID: 32107198 DOI: 10.1016/j.diii.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To retrospectively assess immediate and 1-year success rate of type 2 endoleak (T2E) treatment with ethylene-vinyl-alcohol-polymer using three-dimensional (3D) image fusion guidance with cone beam computed tomography via trans-arterial embolization (TAE) or direct percutaneous sac injection (DPSI). MATERIALS AND METHODS A total of 37 patients with T2E who were treated either using TAE (34/37; 92%) or DPSI (9/37; 8%) were included. There were 34 men and 3 women with a mean age of 86±9 (SD) years (range: 67-104years). Mean aneurysm diameter was 67±14 (SD) mm (range: 42-101mm) at pre-procedure evaluation. Immediate success was complete embolization of the sac and feeding artery. 1-year success was reduction or stability of the aneurysmal sac diameter based on pre-procedure and 12-month follow-up examinations. Safety (treatment-related complications), patient demographics, duration of procedure and contrast volume were reported. RESULTS Immediate and 1-year successful outcomes were reported in 94% (n=32) and 88% (n=28) of patients after TAE and 100% (n=9) and 89% (n=8) after DPSI. T2E treatments were immediately successful for 95% of the procedures (41/43) and for 88% (36/41) at 1year. Overall, T2E treatment was effective in 33 patients (89%). No major complications occurred. Mean procedure time and contrast volume were significantly different between the 2 techniques with respectively 87±16 (SD) min (range: 65-120min) and 75±26 (SD) mL (range: 40-130mL) for TAE and 32±10 (SD) min (range: 20-50min) (P<0.01) and 6±6 (SD) mL (range: 2-22mL) (P<0.01) for DPSI. Mean aneurysm diameter at 1-year was 68±17 (SD) mm (range: 43-101mm). No significant differences in the pre-procedure sac diameter were found at long-term follow-up between patients without T2E and those with persistent T2E (P=0.1) in the successful embolization group (n=33). CONCLUSION TAE or DPSI treatments of T2E with ethylene-vinyl-alcohol-polymer using 3D-image fusion guidance were immediately successful for 95% of the procedures and remained effective for 88%. Longer follow-up is necessary to assess sac stability in the case of persistent endoleak.
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Chin KM, Lee SQ, Lee HJ, Ping CS, Chng JK. Preservation of Stent Graft after Iatrogenic Type III Endoleak during Open Transperitoneal Surgical Intervention for Complicated Type II Endoleak. Ann Vasc Surg 2020; 62:496.e1-496.e7. [DOI: 10.1016/j.avsg.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/26/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
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27
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Internal iliac artery aneurysm embolization with direct percutaneous puncture and thrombin injection. Radiol Case Rep 2020; 15:210-213. [PMID: 31890070 PMCID: PMC6931210 DOI: 10.1016/j.radcr.2019.11.018] [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] [Received: 10/29/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022] Open
Abstract
Endoleak it is the most common complication after endovascular abdominal aortic aneurysm repair and it represents the failure of endovascular treatment. In particular type 2 endoleak is associated with retrograde flow in the aneurysm sac from one or more arterial branches. We describe a reperfusion of the aortic aneurysm sac with slow-flow type II endoleak from the right internal iliac artery aneurysm through the posterior door previously closed with coils, and treatment with direct puncture of the internal iliac artery aneurysm with infixion of human thrombin under ultrasound guidance, not previously described in the literature. In this case the direct puncture of the aneurysm sac was the faster and safer way to treat this patient just because the back door was closed by coils and the entry by the iliac graft. Thrombin reduces significantly the presence of artifacts and give to us the exact extension of thrombosis into the aneurysm sac and the echo-guided offers the advantage of being able to monitor the progression of the thrombotic process induced by thrombin injection in real time.
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Rhee R, Oderich G, Hertault A, Tenorio E, Shih M, Honari S, Jacob T, Haulon S. Multicenter experience in translumbar type II endoleak treatment in the hybrid room with needle trajectory planning and fusion guidance. J Vasc Surg 2019; 72:1043-1049. [PMID: 31882316 DOI: 10.1016/j.jvs.2019.10.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of treating type II endoleaks (T2Ls) after aortic endovascular repair with image guidance translumbar puncture using intraoperative cone beam computed tomography with preprocedure computed tomography angiography fusion in hybrid operating rooms. METHODS Twenty-six consecutive T2L patients in three different institutions were treated between March 2015 and September 2017 by direct translumbar puncture of the abdominal aortic aneurysm (AAA) sac after previous endovascular aortic repair. All patients were treated at a single setting in a cardiovascular hybrid operating room with a workstation featuring needle trajectory planning and guidance software. Aneurysm sac size change from the index treatment, freedom from recurrent endoleak after treatment, demographics, risk factors, and procedure factors were analyzed with univariate analysis. RESULTS All patients (N = 26; 19 male, 7 female; age range, 59-95 years; mean body mass index, 27.44 ± 3.06 kg/m2) underwent treatment for AAA sac expansion or symptoms. Four patients had failed to respond to previous catheter-directed T2L treatment. The most common risk factors included hypertension, hypercholesterolemia, coronary artery disease, tobacco use, and diabetes. Time to initial endoleak diagnosis ranged from 2 to 1914 days (average, 404 days). Aneurysm size after initial repair was 60.3 ± 7.5 mm; sac size had increased 10.1 ± 6.5 mm at the time of treatment. Onyx (Medtronic, Irvine, Calif) or glue (n-butyl cyanoacrylate) and coil embolization was used in 20 cases, and 6 patients were treated with coiling alone. There was no difference between the patients treated with coils alone and those treated with coils or glue (P > .05) in terms of freedom from failure. Total procedure time was 75.9 ± 40.7 minutes; contrast material volume, 19.9 ± 29 mL; fluoroscopy time, 13.74 ± 12.2 minutes; and radiation dose, 121.16 ± 167.7 mGy. After embolization, the mean sac diameter decreased by 2.2 mm to 67.5 ± 9.8 mm. Average follow-up period was 214 days. In 19 patients, the sac reduced in size between 0.2 and 19.1 mm per 100 days; in 2 patients, there was continued AAA expansion (3.4-4.3 mm per 100 days); there was no change in the sac size in 5 patients after the procedure. There were no AAA ruptures during the study period. Once T2L was treated, the recurrence rate was low at 11.5%. CONCLUSIONS This initial multicenter evaluation of the effectiveness of fusion image-guided translumbar obliteration of T2L demonstrated that the technique was effective at all three study centers and showed excellent efficacy to reduce AAA sac size. This may become a more effective and efficient method of treating T2L compared with transarterial or transcaval embolization because of its high success rate and technical ease.
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Affiliation(s)
- Robert Rhee
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY.
| | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Adriene Hertault
- Department of Vascular Surgery, University Hospital of Lille, Lille, France
| | - Emmanuel Tenorio
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Sara Honari
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Theresa Jacob
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
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Aortic graft infection with enteric organism after embolization of late type II endoleak. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:61-64. [PMID: 30911701 PMCID: PMC6416373 DOI: 10.1016/j.jvscit.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
Abstract
An 82-year-old man with a history of endovascular repair for ruptured abdominal aortic aneurysm 6 years ago presented with a type II endoleak and enlarging sac. He had successful transabdominal direct sac puncture embolization but developed fever 2 days postoperatively. Contrast-enhanced computed tomography showed a rim-enhancing collection, and sac aspiration was positive for enteric organisms, confirming endograft infection. The patient underwent graft explantation and neoaortic reconstruction using superficial femoral veins. Three months postoperatively, computed tomography showed complete resolution of fluid collection and no signs of graft infection. This report illustrates direct puncture embolization complicated by endograft infection from enteric bacteria.
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Transgraft sac Embolization Combined with Graft Reinforcement for Refractory Mixed-Type Endoleak. Cardiovasc Intervent Radiol 2018; 42:620-624. [PMID: 30539235 DOI: 10.1007/s00270-018-2144-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
An 80-year-old female underwent EVAR 4 years ago. She presented type II endoleak with sac expansion from 68 to 80 mm during 3-year follow-up after EVAR. Although she underwent translumbar percutaneous sac embolization, the AAA sac continued to enlarge, suggesting mixed-type endoleak including type I, II, and III. Transgraft direct sac angiography revealed endoleak cavity without demonstrable feeding vessel. Transgraft sac embolization using n-butyl cyanoacrylate and graft reinforcement was performed concurrently, without complications. The graft reinforcement consisted of graft extension for eliminating occult type I endoleak, and relining for eliminating occult type III endoleak. Six months after the procedure, CT showed no signs of sac expansion. Transgraft sac embolization combined with graft reinforcement is one of the available options for persistent and refractory mixed-type endoleak.
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Gentsu T, Okada T, Yamaguchi M, Horinouchi H, Katayama N, Ueshima E, Koide Y, Sofue K, Gotake Y, Nomura Y, Tanaka H, Okita Y, Sugimoto K, Murakami T. Type II Endoleak After Endovascular Aortic Aneurysm Repair Using the Endurant Stent Graft System for Abdominal Aortic Aneurysm with Occluded Inferior Mesenteric Artery. Cardiovasc Intervent Radiol 2018; 42:505-512. [PMID: 30515534 DOI: 10.1007/s00270-018-2140-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the incidence of type II endoleak (EL-II) and aneurysm enlargement after endovascular aneurysm repair (EVAR) using the Endurant stent graft in patients with abdominal aortic aneurysm (AAA) with occluded inferior mesenteric artery (IMA). MATERIALS AND METHODS Between 2012 and 2017, 103 patients who underwent EVAR using the Endurant stent graft for AAA with occluded IMA (50 patients with prophylactic embolized IMA and 53 with spontaneous occluded IMA) were retrospectively reviewed. The incidence of EL-II and aneurysm enlargement was evaluated. Predictive factors for persistent EL-II were evaluated based on patient characteristics, preprocedural anatomical characteristics, intraprocedural details, and postprocedural complications. RESULTS Incidence rates of early EL-II and persistent EL-II were 6.8% (7/103 patients) and 4.9% (5/103 patients), respectively. Aneurysm enlargement was found in 10 patients (9.7%), including all 5 patients with persistent EL-II, 3 with de novo EL-II, and 2 with no EL-II. The rates of freedom from aneurysm enlargement at 1, 2, and 3 years were 98.7%, 97.0%, and 93.1% for the group without persistent EL-II, and 80.0%, 60.0%, and 20.0% for the group with persistent EL-II (p < 0.001), respectively. The maximum aneurysm diameter (odds ratio (OR), 1.16; 95% confidence interval (CI), 1.01-1.34; p = 0.0362) and the number of patent lumbar arteries (OR, 2.72; 95% CI, 1.07-6.90; p = 0.0357) were predictive of persistent EL-II. CONCLUSIONS The incidence of EL-II after EVAR using the Endurant stent graft for AAA with occluded IMA was low, but most early EL-II persisted and resulted in aneurysm enlargement. Level of Evidence Level 4, Case Series.
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Affiliation(s)
- Tomoyuki Gentsu
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroki Horinouchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Naoto Katayama
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yutaka Koide
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yasuko Gotake
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshikatsu Nomura
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.,Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, 520, Saisho-ko, Himeji, Hyogo, 670-0981, Japan
| | - Hiroshi Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.,Department of Cardiovascular Surgery, Takatsuki General Hospital, 1-3-13, Kosobe-chou, Takatsuki, Osaka, 569-1192, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Sugawara S, Arai Y, Sone M, Ishiguchi T, Kitagawa A, Aramaki T, Sato R, Morishita H, Takeuchi Y, Inaba Y. Phase II Trial of Transarterial Embolization Using an n-Butyl-2-Cyanoacrylate/Lipiodol Mixture (JIVROSG-0802). Cardiovasc Intervent Radiol 2018; 42:534-541. [DOI: 10.1007/s00270-018-2141-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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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.
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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
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Nakai M, Ikoma A, Loffroy R, Kamisako A, Higashino N, Sonomura T. Endovascular management of endotension by graft reinforcement followed by direct sac embolization. MINIM INVASIV THER 2018; 28:234-240. [DOI: 10.1080/13645706.2018.1518918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Motoki Nakai
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama, Japan
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne, Dijon, France
| | - Atsufumi Kamisako
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama, Japan
| | - Nobuyuki Higashino
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama, Japan
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Żabicki B, Kubiak K, Gabriel M, Juszkat R. Percutaneous direct thrombin injection with hydrodissection to manage type II endoleak after endovascular abdominal aortic aneurysm repair. Pol J Radiol 2018; 83:e461-e464. [PMID: 30655925 PMCID: PMC6334184 DOI: 10.5114/pjr.2018.80250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/09/2018] [Indexed: 11/17/2022] Open
Abstract
Type II endoleak is the most common complication after endovascular abdominal aortic aneurysm repair (EVAR). The management remains controversial. We present a case in which endoleak was successfully treated by direct percutaneous thrombin injection with hydrodissection. This method seems to be a safe and feasible alternative method for treatment of type II endoleak.
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Affiliation(s)
- Bartosz Żabicki
- Department of General and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kinga Kubiak
- Department of General and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Gabriel
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Robert Juszkat
- Department of General and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
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36
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Bryce Y, Lam C(K, Ganguli S, Schiro BJ, Cooper K, Cline M, Oklu R, Vatakencherry G, Peña CS, Gandhi RT. Step-by-Step Approach to Management of Type II Endoleaks. Tech Vasc Interv Radiol 2018; 21:188-195. [DOI: 10.1053/j.tvir.2018.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Ultee KHJ, Büttner S, Huurman R, Bastos Gonçalves F, Hoeks SE, Bramer WM, Schermerhorn ML, Verhagen HJM. Editor's Choice - Systematic Review and Meta-Analysis of the Outcome of Treatment for Type II Endoleak Following Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2018; 56:794-807. [PMID: 30104089 DOI: 10.1016/j.ejvs.2018.06.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/06/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The efficacy and need for secondary interventions for type II endoleaks following endovascular abdominal aortic aneurysm repair (EVAR) remain controversial. This systematic review aimed at investigating the clinical outcomes of different type II endoleak treatments in patients with a persistent type II endoleak after EVAR. DATA SOURCES Embase, Medline via Ovid, Web of Science Core Collection, the Cochrane CENTRAL, and Google Scholar. REVIEW METHODS This systematic review was performed in accordance with the PRISMA Statement. Outcomes of interest were technical and clinical success, change in sac diameter, complications, need for additional interventions, abdominal aortic aneurysm (AAA) rupture, and (AAA related) mortality. Meta-analyses were performed with random effects models. RESULTS A total of 59 studies were included, with a cumulative cohort of 1073 patients with persistent type II endoleak. Peri-operative complications following treatment of type II endoleaks occurred in 3.8% of patients (95% CI 2.7-5.2%), and AAA related mortality was 1.8% (95% CI 1.1-2.7%). Overall technical success was 87.9% (95% CI 83.1-92.1%), while clinical success was 68.4% (95% CI 61.2-75.1%). Among studies detailing sac dynamics, decrease or stable sac, with or without resolution, was achieved in 78.4% (95% CI 70.2-85.6%). Changes in sac diameter following type II endoleak treatment were documented in 157 patients to at least 24 months. Within this group an actual decrease in sac diameter was reported in only 27 of 40 patients. CONCLUSION There is little evidence supporting the efficacy of secondary intervention for type II endoleaks after EVAR. Although generally safe, the lack of evidence supporting the efficacy of type II endoleak treatment leads to difficulty in assessing its merits.
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Affiliation(s)
- Klaas H J Ultee
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Stefan Büttner
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Roy Huurman
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Frederico Bastos Gonçalves
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands; Hospital de Santa Marta, CHLC & NOVA Medical School, Lisbon, Portugal
| | - Sanne E Hoeks
- Department of Anaesthetics, Erasmus University Medical Centre, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, MA, USA
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
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Amin S, Schnabel J, Eldergash O, Chavan A. [Endovascular aneurysm repair (EVAR) : Complication management]. Radiologe 2018; 58:841-849. [PMID: 30083939 DOI: 10.1007/s00117-018-0437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A variety of complications may be experienced during or after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). Acute procedure-related complications include injury to the access vessels, improper endograft placement, ischaemic and systemic complications as well as the postimplantation syndrome. Femoral pseudoaneurysms, endograft migration, kinking or occlusion, endoleaks and endograft infection are complications that have been observed at follow-up. Meticulous patient selection and preprocedural work-up can reduce the incidence of these complications. The majority of the complications, acute as well those at follow-up, can be dealt with endoluminally. It is of essence, however, that a wide variety of catheters, guidewires, stents, stent-grafts and embolics are readily available in the repertoire of the interventionalist. In a small number of patients with endograft occlusion or infection or with bleeding complications/pseudoaneurysms of the access vessels, open surgical intervention may become necessary. To obtain optimal results, close interdisciplinary co-operation, especially between the interventionist, the vascular surgeon and the anaesthetist is mandatory.
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Affiliation(s)
- S Amin
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - J Schnabel
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - O Eldergash
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - A Chavan
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland.
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Transabdominal Direct Sac Puncture Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Interv Radiol 2018; 29:1167-1173. [DOI: 10.1016/j.jvir.2018.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
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Bryce Y, Schiro B, Cooper K, Ganguli S, Khayat M, Lam CK, Oklu R, Vatakencherry G, Gandhi RT. Type II endoleaks: diagnosis and treatment algorithm. Cardiovasc Diagn Ther 2018; 8:S131-S137. [PMID: 29850425 DOI: 10.21037/cdt.2017.08.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Elective abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm, symptomatic, or rapidly expanding more than 0.5 cm in 6 months. Seventy-five percent of AAAs today are treated with endovascular aneurysm repair (EVAR) rather than open repair. This is fostered by the lower periprocedural mortality, complications, and length of hospital stay associated with EVAR. However, some studies have demonstrated EVAR to result in higher reintervention rates than with open repair, largely due to endoleaks. Type II is the most common, making up 10-25% of all endoleaks. Type II endoleaks, can potentially enlarge and pressurize the aneurysm sac with a risk of rupture. However, many type II endoleaks spontaneously resolve or never lead to sac enlargement. Imaging surveillance and approaches to management of type II endoleaks are reviewed here.
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Affiliation(s)
- Yolanda Bryce
- Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Brian Schiro
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | - Kyle Cooper
- Division of Interventional Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mamdouh Khayat
- Division of Interventional Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Cuong Ken Lam
- Division of Vascular and Interventional Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Geogy Vatakencherry
- Division of Vascular and Interventional Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ripal T Gandhi
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
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Outcomes of type 2 endoleaks detected on venous phase CT arteriography. Diagn Interv Imaging 2017; 99:225-229. [PMID: 29229508 DOI: 10.1016/j.diii.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The majority of type 2 endoleaks (T2EL) are identified on computed tomography angiography (CTA) both on arterial and venous phase. There is a subset of T2EL that are demonstrated only on venous phase CTA. This study was done to report the outcomes of T2EL detected only on venous phase CTA. MATERIALS AND METHODS A total of 261 consecutive T2EL treated via embolization were reviewed for the presence of endoleak demonstrated only on venous phase CTA. A group of 16 patients (12 men, 4 women; mean age, 80.1 years) was identified who had pre-embolization venous phase T2EL. Patients were evaluated for presence of T2EL after embolization, change in aneurysm diameter, and need for further intervention. RESULTS The prevalence of venous phase T2EL was 6.1% (16/261; 95%CI: 3.2%-9.0%). On post-embolization CTA, the rate of successful embolization at 6 months was 2/12 (17%; 95%CI: 0%-38%). At 6-month follow-up, mean change in aneurysm diameter was +2.3mm (n=12; 95%CI: -0.5mm to +5.0mm). In total, 4/16 (25%; 95%CI: 4%-46%) underwent re-embolization and 4/16 (25%, 95%CI: 4%-46%) underwent conversion to open repair. There was one aneurysm rupture, which was successfully treated surgically. CONCLUSION These results suggest that venous phase T2EL are not as responsive to embolization as standard T2EL and emphasize the need to follow patients with venous phase T2EL closely.
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Zehtabi F, Ispas-Szabo P, Djerir D, Sivakumaran L, Annabi B, Soulez G, Mateescu MA, Lerouge S. Chitosan-doxycycline hydrogel: An MMP inhibitor/sclerosing embolizing agent as a new approach to endoleak prevention and treatment after endovascular aneurysm repair. Acta Biomater 2017; 64:94-105. [PMID: 28927932 DOI: 10.1016/j.actbio.2017.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/26/2022]
Abstract
The success of endovascular repair of abdominal aortic aneurysms remains limited due to the development of endoleaks. Sac embolization has been proposed to manage endoleaks, but current embolizing materials are associated with frequent recurrence. An injectable agent that combines vascular occlusion and sclerosing properties has demonstrated promise for the treatment of endoleaks. Moreover, the inhibition of aneurysmal wall degradation via matrix metalloproteinases (MMPs) may further prevent aneurysm progression. Thus, an embolization agent that promotes occlusion, MMP inhibition and endothelial ablation was hypothesized to provide a multi-faceted approach for endoleak treatment. In this study, an injectable, occlusive chitosan (CH) hydrogel containing doxycycline (DOX)-a sclerosant and MMP inhibitor-was developed. Several CH-DOX hydrogel formulations were characterized for their mechanical and sclerosing properties, injectability, DOX release rate, and MMP inhibition. An optimized formulation was assessed for its short-term ability to occlude blood vessels in vivo. All formulations were injectable and gelled rapidly at body temperature. Only hydrogels prepared with 0.075M sodium bicarbonate and 0.08M phosphate buffer as the gelling agent presented sufficient mechanical properties to immediately impede physiological flow. DOX release from this gel was in a two-stage pattern: a burst release followed by a slow continuous release. Released DOX was bioactive and able to inhibit MMP-2 activity in human glioblastoma cells. Preliminary in vivo testing in pig renal arteries showed immediate and delayed embolization success of 96% and 86%, respectively. Altogether, CH-DOX hydrogels appear to be promising new multifunctional embolic agents for the treatment of endoleaks. STATEMENT OF SIGNIFICANCE An injectable embolizing chitosan hydrogel releasing doxycycline (DOX) was developed as the first multi-faceted approach for the occlusion of blood vessels. It combines occlusive properties with DOX sclerosing and MMP inhibition properties, respectively known to prevent recanalization process and to counteract the underlying pathophysiology of vessel wall degradation and aneurysm progression. After drug release, the biocompatible scaffold can be invaded by cells and slowly degrade. Local DOX delivery requires lower drug amount and decreases risks of side effects compared to systemic administration. This new gel could be used for the prevention or treatment of endoleaks after endovascular aneurysm repair, but also for the embolization of other blood vessels such as venous or vascular malformations.
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Mewissen MW, Jan MF, Kuten D, Krajcer Z. Laser-Assisted Transgraft Embolization: A Technique for the Treatment of Type II Endoleaks. J Vasc Interv Radiol 2017; 28:1600-1603. [PMID: 29056193 DOI: 10.1016/j.jvir.2017.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022] Open
Abstract
A transgraft embolization (TGE) technique was performed in a patient to treat a type II endoleak. Using a transfemoral arterial approach, the endograft was punctured using a coronary laser catheter aimed toward the type II endoleak nidus, which was treated with Onyx (Medtronic, Minneapolis, Minnesota). TGE resulted in successful embolization, as demonstrated on 1-year follow-up CT angiography, which showed complete elimination of the type II endoleak and shrinkage of the aneurysmal sac. TGE is an alternative to transarterial embolization, translumbar embolization, and transcaval embolization.
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Affiliation(s)
- Mark W Mewissen
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 330, Milwaukee, WI 53215.
| | - M Fuad Jan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 330, Milwaukee, WI 53215
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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.
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Haq IU, Kelay A, Davis M, Brookes J, Mastracci TM, Constantinou J. Ten-year single-centre experience with type II endoleaks: Intervention versus observation. Vasc Med 2017; 22:316-323. [PMID: 28436300 DOI: 10.1177/1358863x17704315] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Our objective was to determine the relative merits of intervention or observation of type II endoleaks (T2Ls). A retrospective analysis was performed on 386 infra-renal endovascular aneurysm repair (IR-EVAR) patients from 2006 to 2015. Annual surveillance imaging of patients undergoing EVAR at our centre were analysed, and all endoleaks were subjected to a multidisciplinary team meeting for consideration and treatment. In the 10-year time frame, 386 patients (79.5±8.7 years) underwent an IR-EVAR. Eighty-one patients (21.0%) developed a T2L and intervention was undertaken in 28 (34.6%): 17 (60.7%) were treated via a transarterial approach (TA) and 11 (39.3%) using the translumbar approach (TL). Fifty-three patients (65.4%) with T2Ls were managed conservatively. Patients who received T2L treatment had a greater proportion of recurrent T2Ls than patients who were conservatively managed ( p=0.032). T2Ls associated with aneurysmal growth were more resistant to treatment than those where there was no change or a decrease in aneurysm size during follow-up (0.033). There was no significant difference in the TA and TL approach with respect to endoleak repair success ( p=0.525). Treatment of a T2L did not confer a survival advantage compared to conservative management ( p=0.449) nor did the choice of either the TA or TL approach ( p=0.148). Our study suggests the development of a T2L associated with aneurysm growth may represent an aggressive phenotype that is resistant to treatment. However, this did not lead to an increased risk of mortality over follow-up. Neither a transarterial nor a translumbar approach to treating a T2L conferred superiority.
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Affiliation(s)
- Ikram-Ul Haq
- 1 Imperial College School of Medicine, London, UK
| | - Arun Kelay
- 2 Aortic Team, Royal Free London, London, UK
| | - Meryl Davis
- 2 Aortic Team, Royal Free London, London, UK
| | - Jocelyn Brookes
- 3 Division of Radiology, University College Hospital, London, UK
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Marcelin C, Le Bras Y, Petitpierre F, Midy D, Ducasse E, Grenier N, Cornelis F. Safety and efficacy of embolization using Onyx ® of persistent type II endoleaks after abdominal endovascular aneurysm repair. Diagn Interv Imaging 2017; 98:491-497. [PMID: 28196614 DOI: 10.1016/j.diii.2017.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To retrospectively evaluate the safety and efficacy of embolization of persistent type II endoleaks occurring after abdominal endovascular aneurysm repair (EVAR) using ethylene vinyl alcohol copolymer (Onyx®). MATERIAL AND METHODS Between 2008 and 2016, 28 consecutives patients (25 men, 3 women) with a mean age of 75.3years±9 (SD) (range: 59-90years) were treated for 29 persistent type II endoleaks with increasing aneurysm size>5mm occurring after EVAR. A total of 35 embolization procedures were performed using Onyx®, via a transarterial route (n=25) or direct puncture (n=10), with or without additional metallic coils. The endpoints were to evaluate the clinical efficacy, corresponding to the stabilization or decrease of aneurism size, and the technical efficacy, corresponding to the ability to complete the embolization. RESULTS No severe complications were observed during and after embolization. The primary and secondary clinical efficacies were 75% (21/28) and 96.4% (27/28), respectively. Overall primary technical efficacy rate was 58.6% (17/29), greater for transarterial technique (72.8%) than for direct puncture (14.3%) (P=0.01). Secondary technical efficacy was 72.4% (21/29), with no differences between transarterial (81.8%) and direct puncture (42.8%) (P=0.06). CONCLUSION Embolization with Onyx® of type II endoleaks after EVAR appears a safe and effective procedure.
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Affiliation(s)
- C Marcelin
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Y Le Bras
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Petitpierre
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - D Midy
- Department of vascular surgery, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - E Ducasse
- Department of vascular surgery, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - N Grenier
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Cornelis
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Comparison of Type II Endoleak Embolizations: Embolization of Endoleak Nidus Only versus Embolization of Endoleak Nidus and Branch Vessels. J Vasc Interv Radiol 2017; 28:176-184. [DOI: 10.1016/j.jvir.2016.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 11/22/2022] Open
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Treatment of Type II Endoleak and Aneurysm Expansion after EVAR. Ann Vasc Surg 2017; 39:56-66. [DOI: 10.1016/j.avsg.2016.08.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022]
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Boniakowski AE, De Martino RR, Coleman DM, Eliason JL, Goodney PP, Rectenwald JE. The natural history of type II endoleaks after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. J Vasc Surg 2016; 64:1645-1651. [DOI: 10.1016/j.jvs.2016.04.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/28/2016] [Indexed: 10/20/2022]
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Iliac Limb Perigraft Access with Robotic Catheter Assistance for Type 2 Endoleak Embolization. Ann Vasc Surg 2016; 38:317.e5-317.e7. [PMID: 27531089 DOI: 10.1016/j.avsg.2016.05.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/10/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022]
Abstract
Retrograde perigraft access to the aneurysmal sac for type 2 endoleak embolization is a relevant alternative to standard transarterial and translumbar approaches. Entering the space between the graft and the iliac artery requires support and pushability, and might be challenging with standard endovascular catheters. We describe the case of a 78-year-old woman with an enlarging aneurysm due to type 2 endoleak, 3 years after EVAR. Despite multiple attempts at manual catheterization, we were unable to engage the space between the iliac wall and the stent graft. The assistance of a robotic catheter allowed for precise positioning of the wire and catheter, maximizing pushability. This permitted fast wire access to the perigraft space and facilitated catheter progress to the sac expeditiously. Endovascular robotic catheter assistance allows optimal support for such retrograde perigraft navigation for type 2 endoleak embolization.
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