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
Results
Technical success of the procedure was defined as the successful deployment of embolization material to the endoleak cavity demonstrated by: - a stable intrasac invasive pressure within an aneurysm that had a previous systolicdiastolic waveform or its reduction by a minimum of 50 mm Hg,
or both. - Presence of stable contrast inside the sac at the end of the procedure Clinical success was defined as absence of endoleak without enlargement of the aneurysm sac on follow-up CTA.
A change in aneurysm size ≥ 5 mm was considered significant at 1 year follow-up.
Bleeding that needed blood transfusion,
dissections,
aneurysm rupture,
distal peripheral embolization and death were considered major complications. Minor complication were considered thrombophlebitis and haematoma at site puncture. Afferent and efferent branches had been detected in the whole cohort of patients on preoperative CT imaging.
All patients were matched as comorbidities,
intraprocedural and follow-up results and are reported in table I and II (Table I,
Table II).
The first nine patients were treated performing unselective transcaval endoleak embolization.
Five of them were treated with this technique after a trans-arterial embolization attempt: two after a transarterial embolization failure and three were affected by type II endoleak recurrence.
In four patients direct uTCEE was performed.
In this cohort
of patients the obtained technical success was 100%,
however in four patients endoleak recurrence was pointed out at 9.75 ± 3.9 months of the follow-up period.
In particular one patient at 3 months arrived at emergency department suffering from severe abdominal pain with a significant aneurysm enlargement and wall rupture diagnosed at CT examination and, therefore,
underwent the surgical option with resection and replacing of the abdominal aortic aneurysm.
The other three patients underwent a new treatment of uTCEE of the inflow and out-flow vessels,
with no type 2 endoleak recurrence in the follow-up period. Mean intrasac pressure before and after uTCEE was respectively 58.6 ± 18.4 mmHg
(range: 51-105) with evidence of a systolic-diastolic wave in 1 patient,
and 6.5 ± 1.2 mmHg (range: 4-9) after the procedure.
The average fluoroscopy time was 15.4 ± 4.1 min (range: 13-41 min).
Mean follow-up period of the nine patients treated with the uTCEE was 25.9 ± 11.0 months.
In the second period of our experience,
we decided to perform directly the sTCEE attempt and this technique was performed and feasible in consecutive 17 cases.
Mean intrasac pressure before and after sTCEE was respectively 63.6 ± 15.2 mmHg (range: 43-120) with evidence of a systolic-diastolic wave in 10 patients,
and 7.8 ± 2.3 mmHg (range: 5-12) after the procedure.
Mean fluoroscopy time was 18.4 ± 5.6 minutes
(range: 10-35).
Mean follow-up period of all patients treated with the sTCEE was 24.1 ± 7.2 months.
No major complications were observed intra-and peri-procedurally. Mean follow-up period of all treated patients resulted 24.1 ± 8.8 months. Afferent and efferent branches had been detected in the whole cohort of patients on preoperative CT imaging.
Before TCEE,
the mean arterial pressure was 113 mm Hg,
and no significant changes were observed during and after the procedure.
No significant changes in pressure related to catheter position were observed before or after embolization. At unenhanced CT scan 24 hours after treatment,
contrast medium was still seen inside the sac in all patients.
As a minor complication,
16 patients (61.5 %) reported a dull lumbar pain during transcaval puncture solved spontaneously.
During the follow-up period at 3 days,
we observed minor complications in only two (7.7%) of 26 patients.
A thrombophlebitis occurred in the common femoral vein that extended into the distal tract of the external iliac vein.
This was related to the percutaneous puncture and was successfully managed with medical treatment (cefotaxime and heparin),
without any sequelae.
The maximum aneurysm diameter was reduced in 22 patients,
with a mean diameter of 68 mm (range,
50 to 88 mm) and a mean reduction of 3 mm (range,
2 to 10 mm). Technical success was 100% in both uTCEE and sTCEE. Clinical success of uTCEE was obtained in 5 (55.6 %) of 9 Patients; clinical success of sTCEE resulted in all patients (100%) with no observed type II endoleak during the follow up period.