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Mulatti GC, Joviliano EE, Pereira AH, Fioranelli A, Pereira AA, Brito-Queiroz A, Von Ristow A, Freire LMD, Ferreira MMDV, Lourenço M, De Luccia N, Silveira PG, Yoshida RDA, Fidelis RJR, Boustany SM, de Araujo WJB, de Oliveira JCP. Brazilian Society for Angiology and Vascular Surgery guidelines on abdominal aortic aneurysm. J Vasc Bras 2023; 22:e20230040. [PMID: 38021279 PMCID: PMC10648059 DOI: 10.1590/1677-5449.202300402] [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: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
The Brazilian Society of Angiology and Vascular Surgery, through the Guidelines Project, presents new Abdominal Aortic Aneurysm Guidelines, on the subject of care for abdominal aortic aneurysm patients. Its development prioritized descriptive guidelines, using the EMBASE, LILACS, and PubMed databases. References include randomized controlled trials, systematic reviews, meta-analyses, and cohort studies. Quality of evidence was evaluated by a pair of coordinators, aided by the RoB 2 Cochrane tool and the Newcastle Ottawa Scale forms. The subjects include juxtarenal aneurysms, infected aneurysms, and new therapeutic techniques, especially endovascular procedures. The current version of the guidelines include important recommendations for the primary topics involving diagnosis, treatment, and follow-up for abdominal aortic aneurysm patients, providing an objective guide for medical practice, based on scientific evidence and widely available throughout Brazil.
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Affiliation(s)
- Grace Carvajal Mulatti
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto - FMRP, Ribeirão Preto, SP, Brasil.
| | - Adamastor Humberto Pereira
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.
| | | | - Alexandre Araújo Pereira
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.
| | - André Brito-Queiroz
- Universidade Federal da Bahia - UFBA, Hospital Ana Nery, Salvador, BA, Brasil.
| | - Arno Von Ristow
- Pontifícia Universidade Católica do Rio de Janeiro - PUC-Rio, Rio de Janeiro, RJ, Brasil.
| | | | | | | | - Nelson De Luccia
- Universidade de São Paulo - USP, Faculdade de Medicina, São Paulo, SP, Brasil.
| | | | - Ricardo de Alvarenga Yoshida
- Universidade Estadual Paulista “Júlio de Mesquita Filho” - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
| | | | - Sharbel Mahfuz Boustany
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.
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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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3
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Iwakoshi S, Ogawa Y, Dake MD, Ono Y, Higashihara H, Ikoma A, Nakai M, Taniguchi T, Ogi T, Kawada H, Tamura A, Ieko Y, Tanaka R, Sohgawa E, Nagatomi S, Woodhams R, Ikeda O, Mori K, Nishimaki H, Koizumi J, Senokuchi T, Hagihara M, Shimohira M, Takasugi S, Imaizumi A, Higashiura W, Sakaguchi S, Ichihashi S, Inoue T, Inoue T, Kichikawa K. Outcomes of embolization procedures for type II endoleaks following endovascular abdominal aortic repair. J Vasc Surg 2023; 77:114-121.e2. [PMID: 35985566 DOI: 10.1016/j.jvs.2022.07.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the mid-term outcomes of embolization procedures for type II endoleak after endovascular abdominal aortic repair, and clarify the risk factors for aneurysm enlargement after embolization procedures. METHODS This was a retrospective multicenter registry study enrolling patients who underwent embolization procedures for type II endoleaks after EVAR from January 2012 to December 2018 at 19 Japanese centers. The primary end point was the rate of freedom from aneurysm enlargement, more than 5 mm in the aortic maximum diameter, after an embolization procedure. Demographic, procedural, follow-up, and laboratory data were collected. Continuous variables were summarized descriptively, and Kaplan-Meier analyses and a Cox regression model were used for statistical analyses. RESULTS A total of 315 patients (248 men and 67 women) were enrolled. The average duration from the initial embolization procedure to the last follow-up was 31.6 ± 24.6 months. The rates of freedom from aneurysm enlargement at 3 and 5 years were 55.4 ± 3.8% and 37.0 ± 5.2%, respectively. A multivariate analysis revealed that a larger aortic diameter at the initial embolization procedure and the presence of a Moyamoya endoleak, defined as heterogeneous contrast opacity with an indistinct faint border, were associated with aneurysm enlargement after embolization management. CONCLUSIONS The embolization procedures were generally ineffective in preventing further expansion of abdominal aortic aneurysms in patients with type II endoleaks after EVAR, especially in patients with a large abdominal aortic aneurysm and/or a presence of a Moyamoya endoleak.
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Affiliation(s)
| | - Yukihisa Ogawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Michael D Dake
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ
| | - Yusuke Ono
- Department of Radiology, Osaka University, Suita, Japan
| | | | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Motoki Nakai
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | | | - Takahiro Ogi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Akio Tamura
- Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Yoshirou Ieko
- Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Ryoichi Tanaka
- Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoru Nagatomi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Reiko Woodhams
- Department of Radiology, Kitazato University, Tokyo, Japan
| | - Osamu Ikeda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kensaku Mori
- Department of Radiology, Tsukuba University, Tsukuba, Japan
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Jun Koizumi
- Department of Radiology, Tokai University, Tokai, Japan
| | - Terutoshi Senokuchi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - Makiyo Hagihara
- Department of Radiology, Aichi Medical University, Nagakute, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shohei Takasugi
- Department of Radiology, Tottori University Hospital, Tottori, Japan
| | - Akira Imaizumi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Wataru Higashiura
- Department of Radiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Shoji Sakaguchi
- Department of Radiology, Matsubara Tokusyukai Hospital, Matsubara, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Takeshi Inoue
- Department of Central Radiology, Nara Medical University, Kashihara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Japan
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4
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Berczeli M, Chinnadurai P, Osztrogonácz P, Peden EK, Bavare CS, Sótonyi P, Chang SM, Lumsden AB. Dynamic CT angiography is more accurate in diagnosing endoleaks than standard triphasic CT angiography and enables targeted embolization. Ann Vasc Surg 2022; 88:318-326. [PMID: 35817381 DOI: 10.1016/j.avsg.2022.06.014] [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] [Received: 04/14/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The primary objective was to compare the accuracy of dynamic CT angiography (d-CTA) with standardized triphasic contrast enhanced CT angiography (t-CTA) in diagnosing endoleak type after endovascular aortic repair (EVAR) using digital subtraction angiography (DSA) as reference standard. The secondary objective was to study the impact of d-CTA on image-fusion guided endoleak embolization. MATERIALS AND METHODS Retrospective review of patients who underwent d-CTA imaging after EVAR between March 2019 and July 2021 was performed. De-identified images were independently reviewed by two-two blinded readers to document endoleak type and target vessels. Impact of d-CTA-guided embolization was evaluated by number of planning angiograms, radiation exposure and accuracy of target vessel overlay. RESULTS During the study period, 52 patients underwent d-CTA, 19 had all three modalities available for analysis. DSA imaging confirmed 4(21.0%) type-I, 14(73.7%) type-II and 1(5.3%) type-III endoleak. Findings from d-CTA matched with DSA in 19/19 cases (100%), whereas t-CTA matched in 14/19 cases (73.7%). In type-II endoleaks, number of target vessels identified by d-CTA, t-CTA and DSA were 23, 17 and 16 respectively. Mean dose-length product from d-CTA and t-CTA was 1445±551 and 1612±530 mGy*cm (p=0.26). Nine patients underwent d-CTA-guided type-II endoleak embolization, using a median of 1(range:1-4) planning angiogram before embolization utilizing 21.6(±8.7)% of total procedural radiation dose. Target vessel overlay was accurate in 9/9(100%) cases. CONCLUSION Dynamic, time-resolved CTA is more accurate compared to standardized triphasic contrast enhanced CTA in diagnosing endoleak type after EVAR. In type-II endoleak, d-CTA better identified target vessels and enabled safe, targeted embolization.
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Affiliation(s)
- Marton Berczeli
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX; Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary.
| | - Ponraj Chinnadurai
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX; Siemens Medical Solutions USA Inc., Malvern, PA
| | - Peter Osztrogonácz
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX; Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Eric K Peden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Charudatta S Bavare
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Su Min Chang
- Department of Cardiology, Houston Methodist Hospital, Houston, TX
| | - Alan B Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
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5
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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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Akmal MM, Pabittei DR, Prapassaro T, Suhartono R, Moll FL, van Herwaarden JA. A systematic review of the current status of interventions for type II endoleak after EVAR for abdominal aortic aneurysms. Int J Surg 2021; 95:106138. [PMID: 34637951 DOI: 10.1016/j.ijsu.2021.106138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/18/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the mid- and long-term outcomes of type II endoleak treatment after EVAR and the technical aspects of different techniques to exclude endoleaks which different embolic agents. METHODS A systematic review was performed using the approach recommended by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for meta-analyses of interventional studies. The comprehensive search was conducted using the following database: MEDLINE, EMBASE, and the Cochrane Library. Patient characteristic, intervention approaches, embolic agents, and results at mid and long term follow up were studied. RESULTS A total of 6 studies corresponding to a total of 141 patients fulfilled the inclusion criteria with a mean age of 73-78.6 years and a mean duration of follow up varying from 25 to 42 months. There were different techniques for embolization used (translumbar, transarterial, and transcaval approach) with various types of embolic agents. In all studies, the indication for embolization of the type II endoleaks was sac enlargement of more than 5 mm. A wide range of technical success rate was reported regardless of the intervention strategy being used (17,6%-100%). The overall technical success rate of all studies was 62%. CONCLUSION This systematic review shows that there is a wide variety of techniques to exclude a persistent type II endoleak. Different kinds of embolic agents have be used. Due to a lack of peer reviewed data on longterm follow-up, it was not possible to come to recommendations what treatment would be the best for a durable exclusion of a persistent type II endoleak after an initially successful EVAR. There remains an urgent need for proper executed studies, either randomized or with close observation in relation to longer follow-up.
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Affiliation(s)
- Marethania M Akmal
- Departement of vascular surgery, University Medical Center Utrecht, Utrecht, the Netherlands Vascular surgery Division, Departement of Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Indonesia Departement of Physiology, Hasanudin University, Indonesia Departement of vascular surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature. J Clin Med 2021; 10:jcm10214841. [PMID: 34768362 PMCID: PMC8584511 DOI: 10.3390/jcm10214841] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.
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8
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Dinoto E, Ferlito F, Urso F, Evola S, Bajardi G, Pecoraro F. Trans-limb embolization for treatment of Type 2 endoleak post EVAR: Case report. Int J Surg Case Rep 2021; 85:106238. [PMID: 34343793 PMCID: PMC8349994 DOI: 10.1016/j.ijscr.2021.106238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Type 2 endoleaks (T2EL) occur after 10%–25% of endovascular abdominal aortic aneurysm repairs and increase the risk factor of endograft repair failure and rupture. Herein we report a case of endovascular treatment of T2EL where we performed a trans-limb embolization. Presentation of case A 63-years-old male previously treated for AAA with endovascular aortic aneurysms repair (EVAR), showed an angio-CT scan followup with a type 2 endoleak fed from inferior mesenteric artery (AMI) with growth of AAA greater of 1 cm than preoperative CT-scan and increase of chronic lumbar pain. Due to high risk of rupture was performed a trans-limb embolization with complete sealing. The 6 months CT-angiography showed complete type 2 endoleak exclusion without changes of AAA. Discussion The risk of aneurysm rupture in the presence of an isolated T2EL is exceptionally low. However, when a persistent T2EL is associated with a significant sac size increase, commonly considered as at least 5 mm over 6 months, should be treated. Detachable coils are repositionable, allowing an extremely precise deployment and subsequent embolization of different targets. Conclusion In this experience trans-limb embolization was feasible and this tool should be taken in account especially when no other surgical options exists. Type 2 endoleaks (T2EL) are a risk factor for endograft repair failure and rupture. T2EL are the most common endoleaks and remain the main cause of repeat intervention. Trans-limb embolization is an innovative technique for T2EL without standard access. Concerto are detachable coils repositionable allowing an extreme precise deployment.
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Affiliation(s)
- E Dinoto
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
| | - F Ferlito
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - F Urso
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - S Evola
- Unit of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) 'G. D'Alessandro', University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy
| | - G Bajardi
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - F Pecoraro
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
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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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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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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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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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13
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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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14
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Tsuchiya S, Saiga A, Yokota H, Nishiyama A, Kubota Y, Horikoshi T, Uno T. Hemoptysis Due to Type II Endoleak after Thoracic Endovascular Aortic Repair: Successful Treatment with Percutaneous CT-Guided Embolization. INTERVENTIONAL RADIOLOGY 2020; 5:23-26. [PMID: 36284834 PMCID: PMC9550394 DOI: 10.22575/interventionalradiology.2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/25/2019] [Indexed: 11/02/2022]
Abstract
An 81-year-old woman presented with massive hemoptysis. She had a history of total arch replacement with an elephant trunk followed by concomitant antegrade thoracic endovascular aortic repair for the aortic arch and the descending aortic aneurysm. Computed tomography (CT) showed expansion of the aortic aneurysm with type II endoleak, lung parenchymal consolidation, and ground-glass opacity. An aortopulmonary fistula was suspected. Surgery posed a very high risk for the patient; hence, a less invasive approach was considered. Left subclavian arteriography revealed a type II endoleak. A transarterial approach would be difficult due to the small and tortuous access route and longer procedure time. Therefore, CT-guided puncture embolization was performed. She had no recurrence of hemoptysis for 1.4 years after the embolization.
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Affiliation(s)
- Satoshi Tsuchiya
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University
| | | | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University
| | | | | | | | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University
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15
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D'Oria M, Mastrorilli D, Ziani B. Natural History, Diagnosis, and Management of Type II Endoleaks after Endovascular Aortic Repair: Review and Update. Ann Vasc Surg 2020; 62:420-431. [PMID: 31376537 DOI: 10.1016/j.avsg.2019.04.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/02/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Mayo Clinic Gonda Vascular Center, Rochester, MN; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy.
| | - Davide Mastrorilli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Barbara Ziani
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
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16
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Ogawa Y, Nishimaki H, Fujiwara K, Nathan IK, Iraha T, Chiba K, Kotoku A, Maruhashi T, Mimura H, Miyairi T. A Novel Technique for the Treatment of Type 2 Endoleak After Endovascular Aortic Repair: Sac Embolization with Balloon Occlusion of the Aorta (SEBOA). Cardiovasc Intervent Radiol 2019; 42:1488-1493. [PMID: 31363897 DOI: 10.1007/s00270-019-02299-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We presented a new method of sac embolization using n-butyl-cyanoacrylate (NBCA) with balloon occlusion of the aorta (SEBOA) that can facilitate decreasing flow rate of the involved branches with the goal of type 2 endoleak resolution after endovascular aortic repair (EVAR). TECHNIQUE This technique is demonstrated in six patients who required type 2 endoleak treatment including previous technical failure. A transarterial approach was performed in four patients and transabdominal direct puncture in two. Technical success was defined as complete embolization of both involved branches and sac on postoperative CT. Sacography under balloon occlusion of the aorta demonstrated decreased flow rate of the all involved branches in all patients. SEBOA was performed using 25 or 33% of NBCA diluted with lipiodol. Technical success was obtained in 3 of 6 patients, and one major complication was observed with adhesion of NBCA to the microcatheter resulting in foreign body retention. CONCLUSION SEBOA may help solve the difficulty of type 2 endoleak treatment after EVAR as decreased flow rate of the involved branches under balloon occlusion of the aorta was achieved in all patients. However, protocols regarding concentration of NBCA or using other embolic materials are needed to improve the success rate.
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Affiliation(s)
- Yukihisa Ogawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Keishi Fujiwara
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Itoga K Nathan
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA, 94305, USA
| | - Tomotaka Iraha
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kiyoshi Chiba
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Akiyuki Kotoku
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takaaki Maruhashi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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17
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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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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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Reply to: "Embolization of Type II Endoleaks". J Vasc Interv Radiol 2017; 28:774-775. [PMID: 28431660 DOI: 10.1016/j.jvir.2017.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/22/2022] Open
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20
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Funaki B. Embolization of Type II Endoleaks. J Vasc Interv Radiol 2017; 28:773-774. [PMID: 28431659 DOI: 10.1016/j.jvir.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brian Funaki
- Department of Radiology, University of Chicago Medicine, 5840 S. Maryland Avenue, Chicago, IL 60637
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