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
Purpose
The endovascular repair of abdominal aortic aneurysms (EVAR) may be complicated by the incomplete exclusion of blood flow to the aneurysm sac.
This complication has been defined as endoleak by White et al (1).
The incomplete sealing off of the graft to the native vascular system is defined as type I endoleak.
Leaks related to fabric tears,
graft disconnection,
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 and clinical failures of EVAR treatment.
Endovascular or surgical treatment is mandatory in these conditions (2,3). Notably,
when an EVAR is successful,
as defined as complete sealing at the attachment sites,
blood flow into the aneurysm sac can still occur.
The reperfusion is usually due to the patency of several collateral branches,
such as from the inferior mesenteric artery (IMA), the superior mesenteric artery,
the sacral artery and the lumbar arteries.
This condition is known as a type II endoleak (2-4). The management of patients with type II endoleak is a source of continuing debate in the literature.
Even though type II endoleak can lead to the late rupture of the aneurysm sac and resultant clinical failure of endovascular treatment,
there is currently no consensus on the best treatment strategy (5). A reasonable treatment strategy in Patient with type II endoleak may be to intervene in cases of increasing aneurysm size or if the endoleak does not resolve spontaneously within 6 months.
Translumbar endoleak embolization (TLEE) has been shown to be more effective than transarterial endoleak embolization (TAEE).
An alternative embolization technique is transcaval endoleak embolization (TCEE),
which has shown success rates comparable to translumbar and transarterial embolization (6-8). We present our results of treatment of type II endoleak in 26 Patients from January 2007 to April 2011.
Aim of this study is to describe treatment technique,
to assess long-term results and to suggest,
in accordance to our experience,
management of type II endoleak,
currently the most controversial in terms of methods of treatment.