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Giagtzidis I, Papoutsis I, Dimkas T, Diamantidis C, Avgeris G, Karkos C, Papazoglou K. Transarterial Coil Embolization for Type II Endoleak After Endovascular Aneurysm Repair (EVAR). Cureus 2024; 16:e68882. [PMID: 39376809 PMCID: PMC11457928 DOI: 10.7759/cureus.68882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2024] [Indexed: 10/09/2024] Open
Abstract
Background Endovascular aneurysm repair (EVAR) has evolved into treatment of choice for infrarenal abdominal aortic aneurysms (AAA). Type II endoleaks, although frequently benign, can lead to sac enlargement and rupture. Management of these endoleaks by endovascular means can be quite challenging and may require complex techniques and assistance of interventional radiologists, not always available in all vascular units. This is a single-center study of management of type II endoleaks with transarterial coil embolization performed by vascular surgeons and with minimum requirements regarding the necessary equipment. Methods From 2017 to 2022, 13 patients with type II endoleak were treated. Local anaesthesia and transfemoral or transbrachial approach was used. The superficial mesenteric artery (SMA) was catheterized and through the Riolan arch, coiling of the inferior mesenteric artery and/or the sac aneurysm was performed. Results The mean time period between the primary EVAR procedure and the transarterial intervention for the endoleak was 3.9 years. Primary technical success was achieved in 11 (84.6%) patients, while secondary technical success was 12 (92.3%). In the mean follow-up period, which was 2.6 years, the endoleak was treated successfully in 11 (84.6%) patients. Conclusions Transarterial coil embolization of type II endoleaks is a minimal low-cost procedure, with small percentage of complications, high technical and treatment success rates. It could be considered as a first-line treatment of unresolvable type II endoleaks, minimizing the need for open repair.
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Affiliation(s)
- Ioakeim Giagtzidis
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioakeim Papoutsis
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Theodoros Dimkas
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Christos Diamantidis
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Georgios Avgeris
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Christos Karkos
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Papazoglou
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
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2
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Fujitsuna R, Ueda T, Saito H, Matsumoto T, Shirai S, Sugihara F, Hayashi H, Kumita SI. Initial Outcomes of Embolization for Type II Endoleak: Comparison of n-Butyl Cyanoacrylate-Ethiodized Oil Mixture with n-Butyl Cyanoacrylate-Ethiodized Oil-Ethanol Mixture. J Vasc Interv Radiol 2024:S1051-0443(24)00498-6. [PMID: 39094848 DOI: 10.1016/j.jvir.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/04/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE To compare the safety and effectiveness of n-butyl cyanoacrylate (nBCA)-ethiodized oil (NE) mixture and nBCA-ethiodized oil-ethanol (NEE) mixture embolization for Type II endoleak (T2EL) after endovascular aortic repair. MATERIALS AND METHODS This study included 32 patients with 49 procedures who underwent T2EL embolization between January 2008 and June 2022. Cases with no follow-up after embolization, technical failure, treatment with coil only, Type I endoleak at the embolization, and re-embolization were excluded. The resultant final cohort included 24 patients (14 men and 10 women; mean age, 83.3 years [interquartile range, 77-89 years]) who underwent initial T2EL embolization, with 15 patients in the NE group and 9 patients in the NEE group. The 2 groups were compared in terms of adverse events (AEs), freedom from sac enlargement, and freedom from reintervention. RESULTS The follow-up period after embolization for T2EL was 960 days (SD ± 1,007) in the NE group and 484 days (SD ± 192) in the NEE group, without significant differences. No AEs above moderate were observed in either group. The rate of freedom from sac enlargement at 1 year was 65.0% in the NE group and 87.5% in the NEE group (P = .03). The rate of freedom from reintervention at 1 year was 69.2% in the NE group and 100.0% in the NEE group (P = .02). CONCLUSIONS The NEE group had significantly higher rates of freedom from sac enlargement and reintervention at 1 year compared with the NE group. These results suggest that T2EL embolization with NEE may be more effective than that with NE.
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Affiliation(s)
- Ryutaro Fujitsuna
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan.
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hidemasa Saito
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Taiga Matsumoto
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Sayaka Shirai
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumie Sugihara
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiromitsu Hayashi
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
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3
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Dueppers P, D’Oria M, Lepidi S, Calvagna C, Zimmermann A, Kopp R. An Expert-Based Review on the Relevance and Management of Type 2 Endoleaks Following Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. J Clin Med 2024; 13:4300. [PMID: 39124566 PMCID: PMC11312779 DOI: 10.3390/jcm13154300] [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: 07/18/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Ruptured abdominal aortic aneurysms (rAAAs) are life-threatening and require emergent surgical therapy. Endovascular aortic repair for rupture (rEVAR) has become the leading strategy due to its minimal invasive approach with expected lower morbidity and mortality, especially in patients presenting with hemodynamic instability and relevant comorbidities. Following rEVAR, intraoperative angiography or early postinterventional computed tomography angiography have to exclude early type 1 or 3 endoleaks requiring immediate reintervention. Persistent type 2 endoleaks (T2ELs) after rEVAR, in contrast to elective cases, can cause possibly lethal situations due to continuing extravascular blood loss through the remaining aortic aneurysm rupture site. Therefore, early identification of relevant persistent T2ELs associated with continuous bleeding and hemodynamic instability and immediate management is mandatory in the acute postoperative setting following rEVAR. Different techniques and concepts for the occlusion of T2ELs after rEVAR are available, and most of them are also used for relevant T2ELs after elective EVAR. In addition to various interventional embolization procedures for persistent T2ELs, some patients require open surgical occlusion of T2EL-feeding arteries, abdominal compartment decompression or direct surgical patch occlusion of the aneurysm rupture site after rEVAR. So far, in the acute situation of rAAAs, indications for preemptive or intraoperative T2EL embolization during rEVAR have not been established. In the long term, persistent T2ELs after rEVAR can lead to continuous aneurysm expansion with the possible development of secondary proximal type I endoleaks and an increased risk of re-rupture requiring regular follow-up and early consideration for reintervention. To date, only very few studies have investigated T2ELs after rEVAR or compared outcomes with those from elective EVAR regarding the special aspects of persisting T2ELs. This narrative review is intended to present the current knowledge on the incidence, natural history, relevance and strategies for T2EL management after rEVAR.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular Surgery, University of Zurich (UZH), Raemistrasse 100, CH-8008 Zurich, Switzerland; (A.Z.); (R.K.)
- Department of Vascular Surgery, Kantonsspital St. Gallen, CH-9000 St. Gallen, Switzerland
| | - Mario D’Oria
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.D.); (S.L.); (C.C.)
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.D.); (S.L.); (C.C.)
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.D.); (S.L.); (C.C.)
| | - Alexander Zimmermann
- Department of Vascular Surgery, University of Zurich (UZH), Raemistrasse 100, CH-8008 Zurich, Switzerland; (A.Z.); (R.K.)
| | - Reinhard Kopp
- Department of Vascular Surgery, University of Zurich (UZH), Raemistrasse 100, CH-8008 Zurich, Switzerland; (A.Z.); (R.K.)
- Department of Vascular and Endovascular Surgery, University Hospital Regensburg, University of Regensburg, 93053 Regensburg, Germany
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4
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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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5
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Giurazza F, Corvino F, Pane F, Di Serafino M, Niola R. Combined DSA- and US-guided management of acute bleeding: effectiveness of percutaneous glue embolization in six cases. J Ultrasound 2024; 27:179-184. [PMID: 37162728 PMCID: PMC10908745 DOI: 10.1007/s40477-023-00785-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/14/2023] [Indexed: 05/11/2023] Open
Abstract
AIMS This study aims to report on safety and effectiveness of glue embolization of acute hemorrhages performed by US-guided percutaneous direct puncture, in patients where the standard endovascular approach is technically unfavourable. METHODS In this single center retrospective analysis, patients affected by traumatic or non traumatic acute hemorrhages were treated with glue embolization technically performed by US-guided direct puncture. Patients suffered from active bleeding detected at contrast-enhanced Computer Tomography and confirmed at Digital Subtracted Arteriography, with concomitant hemoglobin drop and blood pressure reduction. Six patients were reviewed; hemorrhages occurred in liver parenchima (1), gallbladder (1) and lower limbs (4). Bleedings etiologies were post-traumatic (5) and inflammatory (1); four had extraluminal blushes while 2 were pseudoaneurysms. In five cases (4 limbs and 1 hepatic bleedings) the direct-puncture approach was adopted because of technically unfavourable vascular anatomy for superselective embolization; in one case (cystic artery pseudoaneurysm), an endovascular embolization would entail a high risk of gallbladder ischemia because of its terminal arterial supply. Technical success was defined disappearance of bleeding signs at last arteriography; clinical success was considered stabilization and/or improvement of hemoglobin values and arterial pressure without additional interventions. RESULTS Both technical and clinical successes were obtained in 100% of the cases without major complications. No needle occlusion occurred during glue injection. CONCLUSIONS In this study percutaneous US-guided embolization by direct puncture was a safe and effective approach to manage acute bleedings; it could be considered as an alternative in patients with unfavourable vascular anatomy for the standard catheter-directed endovascular embolization.
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Affiliation(s)
- Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy.
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Francesco Pane
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
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6
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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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7
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Diaz A, Wang E, Bujnowski D, Arimoto R, Armstrong M, Cyberski T, Nordgren R, Seal SM, Kass-Hout T, Roxbury C. Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta-Analysis. Laryngoscope 2023. [PMID: 36789781 DOI: 10.1002/lary.30616] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To compare outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non-embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE). DATA SOURCES Per PRISMA guidelines, PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched for publications prior to or in 2021. MATERIALS AND METHODS Original English manuscripts investigating the resection of JNA with and without preoperative embolization were included. Embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Risk of bias was assessed by the Risk of Bias in Non-randomized Studies-of Interventions method. RESULTS There were 61 studies with 917 patients included. Preoperative embolization was performed in 79.3% of patients. Of those embolized, 75.8% (N = 551) underwent TAE and 15.8% (N = 115) underwent DPE. JNA recurrence in embolized patients was lower than in non-embolized patients (9.3% vs. 14.4%; odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.35, 1.06). DPE resulted in lower rates of disease recurrence (0% vs. 9.5%; OR: 0.066, 95% CI: 0.016, 0.272) and complications (1.8% vs. 21.9%; OR: 0.07, 95% CI: 0.02, 0.3) than TAE. A random effects Bayesian model was performed to analyze the difference in mean blood loss in 6 studies that included both embolized and non-embolized patients. This analysis showed a mean reduction in blood loss of 798 mL in the embolized group. CONCLUSIONS We found embolization decreases blood loss in JNA resection. DPE led to improved recurrence and complication rates when compared to TAE, but future prospective studies are needed to further evaluate which embolization technique can optimize outcomes in JNA. LEVEL OF EVIDENCE NA Laryngoscope, 2023.
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Affiliation(s)
- Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Esther Wang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Daniel Bujnowski
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Ryuji Arimoto
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Mikhayla Armstrong
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Thomas Cyberski
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Stella M Seal
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Christopher Roxbury
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
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8
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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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9
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Comby PO, Guillen K, Chevallier O, Lenfant M, Pellegrinelli J, Falvo N, Midulla M, Loffroy R. Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications. J Clin Med 2021; 10:4320. [PMID: 34640339 PMCID: PMC8509239 DOI: 10.3390/jcm10194320] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/30/2022] Open
Abstract
Endovascular embolization agents are particles and fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude a target vessel, either temporarily or permanently. Vascular embolization agents are available as solids, liquids, and suspensions. Although liquid adhesives (glues) have been used as embolic agents for decades, experience with them for peripheral applications is generally limited. Cyanoacrylates are the main liquid adhesives used for endovascular interventions and have a major role in managing vascular abnormalities, bleeding, and many vascular diseases. They can only be injected as a mixture with ethiodized oil, which provides radiopacity and modulates the polymerization rate. This review describes the characteristics, properties, mechanisms of action, modalities of use, and indications of the cyanoacrylate-Lipiodol® combination for peripheral embolization.
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Affiliation(s)
- Pierre-Olivier Comby
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (P.-O.C.); (M.L.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
| | - Kévin Guillen
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Olivier Chevallier
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Marc Lenfant
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (P.-O.C.); (M.L.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
| | - Julie Pellegrinelli
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Romaric Loffroy
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
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Nolte-Ernsting C, Mecklenbeck FP, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. ROFO : FORTSCHRITTE AUF DEM GEBIETE DER RONTGENSTRAHLEN UND DER NUKLEARMEDIZIN 2021; 193:1426-1435. [PMID: 34139782 DOI: 10.1055/a-1502-7883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Type 2 endoleaks (T2EL) are the most frequent complication following endovascular aortic repair. Multiple studies primarily deal with the technical and clinical success of the embolization of persisting T2EL, thereby revealing controversial outcomes. Current reports rarely focus on the detailed execution of such a complex interventional procedure with respect to the difficult anatomic setting. METHODS The present review provides an in-depth depiction and evaluation of the interventional methodology of the embolization of T2EL in the abdominal aorta with use of ethylene vinyl alcohol copolymer (EVOH). Complicating anatomic conditions are taken into account as well as technical and clinical success rates. RESULTS Using the transarterial approach, there are at least 4 different pathways to access the nidus of a T2EL. CT-guided direct puncture of the aneurysm sac provides an alternative method of high technical success. EVOH with its slow solidification characteristics enables good control to achieve complete filling of the T2EL. During the intervention, however, it remains difficult to meet exactly the embolization endpoint, especially in large T2ELs. CONCLUSION T2EL embolization using EVOH is an effective treatment with low major complication rates when conducted by skilled interventionists with detailed knowledge of diverse complex access routes. KEY POINTS · Many roads lead to Rome to access the nidus of a T2EL including diverse complex transarterial pathways and direct aneurysm sac puncture.. · Ethylene vinyl alcohol co-polymer enables good control for slow filling of the nidus with low risk of major complications.. · Identification of the embolization endpoint remains difficult during the procedure and may result in secondary interventions.. · Successful T2EL embolization requires detailed knowledge of all access routes to the nidus and skilled handling of liquid embolics.. CITATION FORMAT · Nolte-Ernsting C, Mecklenbeck F, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1502-7883.
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Affiliation(s)
- Claus Nolte-Ernsting
- Klinik für Diagnostische und Interventionelle Radiologie, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Frank-Peter Mecklenbeck
- Klinik für Diagnostische und Interventionelle Radiologie, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Alexander Stehr
- Gefäßchirurgische Klinik, Evangelisches Krankenhaus Mülheim an der Ruhr, Germany
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11
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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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12
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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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13
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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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14
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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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15
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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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16
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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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17
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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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18
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Ushijima Y, Asayama Y, Nishie A, Ishigami K, Takayama Y, Okamoto D, Fujita N, Morita K, Honda H. Safety and Efficacy of Embolization Using N-Butyl Cyanoacrylate via a Percutaneous Direct Approach for Endoleaks after Abdominal/Thoracic Endovascular Aortic Repair. INTERVENTIONAL RADIOLOGY 2020; 5:1-9. [PMID: 36284832 PMCID: PMC9550392 DOI: 10.22575/interventionalradiology.2018-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 08/24/2019] [Indexed: 10/31/2022]
Abstract
Purpose: To elucidate the safety and efficacy of embolization using N-butyl cyanoacrylate (NBCA) for endoleaks after abdominal/thoracic endovascular aortic repair (EVAR/TEVAR) via a direct percutaneous approach versus a transarterial approach. Materials and Methods: The retrospective design of the study was approved by the institutional ethics committee, and the requirement for informed written consent was waived. Sixteen patients underwent embolization for endoleaks after EVAR/TEVAR, which was diagnosed as type II, from March 2010 to December 2013 at our institution. The number of embolization sessions was 21. A direct percutaneous approach was used in 10 sessions, and a transarterial approach was used in 11 sessions. There were 11 and 15 embolic sites for the two approaches, respectively. The procedure time, amount of contrast media used, therapeutic effect, and complications were evaluated. Results: The mean procedure time (per embolic site) was 100 min (53-170) in the direct percutaneous approach, which was significantly shorter than the 191 min (76-275) in the transarterial approach. The mean amount of contrast media used during the procedure (per embolic site) was 12.8 ml (3-25) by the direct percutaneous approach, which was significantly lesser than the 71.8 ml (30-180) in the transarterial approach. Local control of the embolic site and interval increase in the size of aneurysm after embolization were not significantly different between the two approaches. In one case each, mesenteric hematoma and migration of the embolic agent occurred with a direct percutaneous approach, and a small arterial injury occurred with the transarterial approach; aneurysmal rupture/perianeurysmal hematoma and neurological dysfunction were not observed. Conclusion: A direct percutaneous approach is a feasible procedure for embolization of endoleaks after EVAR/TEVAR.
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Affiliation(s)
- Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Yoshiki Asayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Yukihisa Takayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Koichiro Morita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
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19
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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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20
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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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21
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Haymet AB, Lee D, Ho-Shon K, Waugh R. When the Conventional Treatment Fails: A Rare Approach to Superior Mesenteric Arterial Embolization. Vasc Endovascular Surg 2019; 54:169-171. [DOI: 10.1177/1538574419886187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Retroperitoneal haemorrhage is a rare but potentially life-threatening event. It may occur either spontaneously or secondary to percutaneous vascular access procedures, trauma, or ruptured aortic, iliac, or mesenteric aneurysms. As a result, the clinical presentation is variable. Computed tomography and/or angiography are vital for diagnosis. Management may range from conservative treatment for stable patients to emergency laparotomy or embolization for catastrophic haemorrhage. Direct percutaneous puncture of a deep intra-abdominal pseudoaneurysm is an accepted but infrequently performed technique due to a number of diagnostic and technical challenges. We describe the successful percutaneous transabdominal angioembolization of a superior mesenteric artery rupture in a 77-year-old woman with a large retroperitoneal haematoma. This was performed after a conventional femoral transarterial approach was unsuccessful.
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Affiliation(s)
| | - Daniel Lee
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Kevin Ho-Shon
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Richard Waugh
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
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22
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Orgera G, Tipaldi MA, Laurino F, Lucatelli P, Rebonato A, Paraskevopoulos I, Rossi M, Krokidis M. Techniques and future perspectives for the prevention and treatment of endoleaks after endovascular repair of abdominal aortic aneurysms. Insights Imaging 2019; 10:91. [PMID: 31549250 PMCID: PMC6757092 DOI: 10.1186/s13244-019-0774-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/22/2019] [Indexed: 12/04/2022] Open
Abstract
The presence of endoleaks remains one of the main drawbacks of endovascular repair of abdominal aortic aneurysms leading to the increase of the size of the aneurysmal sac and in most of the cases to repeated interventions. A variety of devices and percutaneous techniques have been developed so far to prevent and treat this phenomenon, including sealing of the aneurysmal sac, endovascular embolisation, and direct sac puncture. The aim of this review is to analyse the indications, the effectiveness, and the future perspectives for the prevention and treatment of endoleaks after endovascular repair of abdominal aortic aneurysms.
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Affiliation(s)
- Gianluigi Orgera
- Department of Radiology, Sant' Andrea University Hospital La Sapienza, Rome, Italy
| | | | - Florindo Laurino
- Department of Radiology, Sant' Andrea University Hospital La Sapienza, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alberto Rebonato
- The Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Michele Rossi
- Department of Radiology, Sant' Andrea University Hospital La Sapienza, Rome, Italy
| | - Miltiadis Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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23
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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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24
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Al Adas Z, McVinnie DW, Weaver MR, Shepard AD. Compression of endograft limb after translumbar embolization of a type II endoleak using n-butyl cyanoacrylate. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 4:327-330. [PMID: 30761380 PMCID: PMC6298932 DOI: 10.1016/j.jvscit.2018.06.001] [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: 04/03/2018] [Accepted: 06/07/2018] [Indexed: 11/07/2022]
Abstract
Cyanoacrylate “glue” has been used in a variety of surgical disciplines. In vascular surgery, it has been used to seal type II endoleaks after endovascular aneurysm repair. In this case, we report a rare complication after translumbar injection of n-butyl cyanoacrylate to occlude a persistent type II endoleak. The cyanoacrylate resulted in significant compression of the right iliac graft limb with reduced distal perfusion.
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Affiliation(s)
- Ziad Al Adas
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - David W McVinnie
- Division of Interventional Radiology, Henry Ford Hospital, Detroit, Mich
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Hyatt E, McLaughlin JN, Shah H, Kalva SP. Transcaval approach for embolization of type II Endoleak following endovascular aortic aneurysm repair. CVIR Endovasc 2019; 2:3. [PMID: 30687807 PMCID: PMC6325093 DOI: 10.1186/s42155-018-0047-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Type II endoleak is a common complication following endovascular aortic aneurysm repair and can lead to an increased risk of aneurysmal expansion and rupture. The most frequently employed strategies to treat Type II endoleak involves catheterization of the branch vessels responsible for the endoleak or accessing the aneurysm sac through a percutaneous approach. An endovascular transcaval approach for embolization of the aneurysmal sac provides an alternate strategy with comparable success rates. This technique is advantageous when the endoleak is predominantly on the right side of the aneurysm sac and/or when a direct access to the aneurysm sac through a percutaneous approach is not feasible.
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Affiliation(s)
- Eddie Hyatt
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390 USA
| | - Joseph N McLaughlin
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390 USA
| | - Hriday Shah
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390 USA
| | - Sanjeeva P Kalva
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390 USA
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26
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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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27
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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: 107] [Impact Index Per Article: 17.8] [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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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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29
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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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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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