Purpose
to investigate the feasibility and effectiveness of trans-caval endoleak embolization (TCEE) of type Ia,
type II and a combination of type Ia and type II (Ia-II) endoleaks occurring after endovascular repair (EVAR) of abdominal
aortic aneurysm (AAA).
Methods and Materials
MATERIALS AND METHODS
The institutional review board at our institution gave full approval and waiver of informed consent for our retrospective study and had previously approved our treatment protocol.
Written patient informed consent was obtained from each patient prior to treatment.
Clinical indication for treatment was type Ia,
type II or type Ia-II with evidence an increase of the aneurysm sac’s diameter of at least 25 % during post-EVAR follow-up.
The treatment was considered technically feasible,
when the inferior vena cava was found to be...
Results
RESULTS
TCEE
TCEE with combination of coils,
Glubran 2 acrylic glue and thrombin was feasible and effective in all patients with exclusion of all type Ia,
type II and type Ia-II endoleaks.
Mean intrasac pressure before and after TCEE was respectively 63.6 ± 15.2 mmHg (range: 43-89) and 7.8 ± 2.3 mmHg (range: 5-12).
Mean fluoroscopy time was 15.4 ± 4.1 minutes (range: 10-22).
No major or minor complications were observed intra-and peri-procedurally.
All patients reported a dull lumbar pain a during transcaval puncture terminated...
Conclusion
To our knowledge this is the first study reporting the treatment of type Ia,
II and Ia-II endoleaks by TCEE using metal coils,
Glubran 2 acrylic glue and thrombin.
This technique,
when indicated,
is feasible,
does not require high operator skills and can be performed by almost all endovascular specialists in most clinical contexts using a simple C-arch.
The safety and feasibility features of this technique suggest its use as the treatment of choice in type I and II endoleaks in selected patients.
References
REFERENCES
1.
Görich,
J.,
Rilinger,
N.,
Sokiranski,
R.,
et al.
Treatment of leaks after endovascular repair of aortic aneurysms.
Radiology 2000 May; 215(2):414-20.
2.
Veith,
F.J.,
Baum,
R.A.,
Ohki,
T.,
et al.
Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference.
J Vasc Surg 2002; 35:1029–1035
3.
Jacobowitz,
G.R.,
Rosen,
R.J.,
Riles,
T.S.
The significance and management of the leaking endograft.
Semin Vasc Surg 1999; 12:199-206.
4.
Zarins,
C.K.,
Heikkinen,
M.A.,
Lee,
E.S.,
Alsac,
J.M.,
Arko,
F.R.
Short- and...