Trans-caval Endoleak Embolization (TCEE) of Type I and II Endoleaks Occurring after Endovascular Abdominal Aortic Aneurysm Repair (EVAR)

Congress:

ECR 2013

Poster Number:

C-0809

Type:

Scientific Exhibit

Keywords:

Arteries / Aorta, Interventional vascular, CT-Angiography, Fluoroscopy, Embolisation, Catheters, Stents, Aneurysms

Authors:

R. Gandini, M. Chiocchi, D. Morosetti, A. Chiaravalloti, G. Loreni, G. Simonetti; Rome/IT

DOI:

10.1594/ecr2013/C-0809

DOI-Link:

https://dx.doi.org/10.1594/ecr2013/C-0809

Fig. 1: Fig. 1 : Pre-procedural CTA showing II type endoleak from lumbar arteries in...

Fig. 2: Fig. 2: A right transfemoral percutaneous access is obtained in order to place...

Fig. 3: Fig. 3: Post-procedural CTA showing in axial view (A) and MPR reconstruction...

Fig. 4: Fig. 4: Through the right transfemoral percutaneous access the Colapinto needle...

Purpose

The endovascular repair of abdominal aortic aneurysms (EVAR) may be complicated by theincomplete exclusion of blood flow to the aneurysm sac. This complication has beendefined as endoleak by White et al (1). The incomplete sealing off of the graft to the nativevascular system is defined as type I endoleak. Leaks related to fabric tears, graftdisconnection, or disintegration are designated as type III (2-4). Type I and III endoleaks lead to direct arterial flow into the aneurysm sac and are considered technical andclinical failures of EVAR...

Methods and Materials

From January 2007 to April 2011, 26 Patients underwent to a post-EVAR endoleaktreatment.The Institutional Review Board at our institution gave full approval and waiver of informedconsent for our retrospective study and approved our treatment protocol. Written patientinformed consent was obtained from each patient prior to intervention. Diagnosis of type II endoleak was performed with a follow-up computed tomographyangiography (CTA) before the enrollment in the study.The indications for treatment were the same for all Patients: evidence of type II endoleak at12-month follow up in large aneurysm...

Results

Technical success of the procedure was defined as the successful deployment ofembolization material to the endoleak cavity demonstrated by:- a stable intrasac invasive pressure within an aneurysm that had a previous systolicdiastolicwaveform or its reduction by a minimum of 50 mm Hg, or both.- Presence of stable contrast inside the sac at the end of the procedureClinical success was defined as absence of endoleak without enlargement of the aneurysmsac on follow-up CTA. A change in aneurysm size ≥ 5 mm was considered significant at 1year...

Conclusion

Type II endoleak is the most commonly encountered and also the most controversial type ofendoleak. Even though at low-flow, type II endoleaks may prevent thrombosis of the aortic sac andcreate a potential risk of continued aneurysm expansion and potential rupture. Type IIendoleaks account for about 40% of all endoleaks and are reported in 10-25% of EVARcases at 30 days (4,9). The best indicator of hemodynamic significance of a type II endoleak is the associatedchange in the aneurysm sac: if the sac increases in size, higher...

References

1. White GH, Yu W, May J. Endoleak–a proposed new terminology to describeincomplete aneurysm exclusion by endoluminal graft. J Endovasc Surg 1996;3:124-5. 2. White GH, Yu W, May J, Chaufour X, Stephen MS. Endoleak as a complication ofendoluminal grafting of abdominal aortic aneurysms: classification, incidence,diagnosis and management. J Endovasc Surg 1997; 4:152-68. 3. White GH, May J, Waugh RC, Chaufour X, Yu W. Type III and type IV endoleak:toward a complete definition of blood flow in the sac after endoluminal AAA repair.J Endovasc Surg 1998;5:305-9....