Life-Saving Embolization in a Patient with Recurrent Shock Due to a Type II Endoleak after Endovascular Aortic Repair for a Ruptured Abdominal Aortic Aneurysm

Ogawa, Yoshiaki; Nishimaki, Hiroshi; Chiba, Kiyoshi; Ro, Daijun; Ono, Hirokuni; Sakurai, Yoshinori; Fujiwara, Keishi; Murakami, Kenji; Hamaguchi, Shingo; Yagihashi, Kunihiro; Miyairi, Takeshi; Nakajima, Yasuo

doi:10.3400/avd.cr.15-00015

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…Type II endoleak is an important issue in ruptured AAA. Although type II endoleak has low pressure due to retrograde collateral flow, it may induce persistent bleeding through the rupture site, as witnessed by Ogawa et al 8 Even though the NBCA procedure could not prevent type II endoleak completely, hemodynamic stabilization was achieved regardless in our cases. Since NBCA was injected at the rupture site, we believe the glue can seal the rupture site and prevent persistent bleeding even in the presence of a type II endoleak.…”

Section: Discussionmentioning

confidence: 46%

“…7 In ruptured AAA and IAA, when a type II endoleak occurs, bleeding may persist from the rupture site. 8 Several authors have reported that sac embolization using embolic materials such as coils and thrombin during elective EVAR was useful in preventing type II endoleaks. [9][10][11][12][13][14][15][16] Several years ago, Koike et al 17 reported an initial experience with embolization of ruptured AAAs using N-butyl cyanoacrylate (NBCA) in 3 emergency EVAR cases.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

et al. 2020

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Purpose: To evaluate the feasibility and safety of sac embolization with N-butyl cyanoacrylate (NBCA) in emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) in comparison to EVAR without sac embolization. Materials and Methods: Between February 2012 and December 2019, among 44 consecutive patients with ruptured AAA or IAA, 29 underwent EVAR. Of these, 22 patients (median age 77.5 years; 18 men) had concomitant sac embolization using NBCA; the remaining 7 patients (median age 88 years; 6 men) underwent EVAR without sac embolization and form the control group. The technical success, clinical success (hemodynamic stabilization), procedure-related complications, and mortality were compared between the groups. Results: All EVAR procedures and embolizations were successful. The clinical success rates in the NBCA and control groups were 95% (21/22) and 71% (5/7), respectively (p=0.14). There was no complication related to the procedure. Type II endoleak occurred in 4 of 21 patients (19%) in the NBCA group vs none of the control patients. One patient (5%) died in the NBCA group vs 3 (43%) in the controls (p=0.034). Conclusion: Sac embolization using NBCA in emergency EVAR appears to be feasible and safe for ruptured AAA and IAA.

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Section: Discussionmentioning

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

et al. 2020

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“…Although they deliver less blood flow than type 1 endoleaks, type 2 endoleaks have also been reported to cause hemodynamically relevant bleeding out of the rupture site after standard EVAR, leaving the patient in need of an emergency secondary intervention [31]. Here, it is conclusive that if the rupture site is definitely embolized with NBCA, persistent bleeding due to an endoleak will be avoided.…”

Section: Targeted Rupture Site Embolization and Endoleak Managementmentioning

confidence: 99%

Endovascular Aneurysm Sac Embolization for Treatment of Ruptured Aneurysms in the Aortoiliac Segment Using N-Butyl-Cyanoacrylate

Mostafa

Schierenbeck

Trentmann

et al. 2023

Life

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Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization with N-butyl-cyanoacrylate (NBCA). Here, we report our experience of performing this add-on embolization procedure after endovascular aneurysm repair for complex ruptured aneurysms of the aortoiliac segment. Material and Methods We describe six patients (mean age of 75.2 years; all male) with ruptured aneurysms in the visceral aortic and aortoiliac segment in whom a high-volume transarterial aneurysm sac embolization was performed as an add-on therapy to the implantation of an aortic prosthesis. The aim of this add-on intervention was to achieve the definite embolization of the aneurysmal rupture site and to ensure the best possible aneurysmal sealing. We report the feasibility, technical success, and considerations of using NBCA as well as clinical and follow-up imaging results, given their availability. Results Technical success was achieved in all cases. Clinical success was achieved in four cases. No periprocedural complications or reinterventions were reported. The mean full procedure time was 107.8 min. The mean radiation dose was 12,966.1 cGy/cm2. A mean amount of 10.7 mL of NBCA mixed with lipiodol in a 1:3 to 1:5 ratio was used for all patients. Available follow-up imaging up to 36 months after the procedure showed no aneurysm progression or endoleaks. In two patients, the NBCA cast had almost fully dissolved over the course of follow-up. Conclusions Our study underscores the notion that aneurysm sac embolization using high volumes of NBCA with ethiodized oil as an embolic agent is a feasible and add-on treatment option for optimizing the exclusion of the aneurysm from patients with ruptured aneurysms in the aortoiliac segment.

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“…In some cases, expansion of retroperitoneal hematoma can cause abdominal compartment syndrome (ACS). 22 ) Previous work has shown that injections of N-butyl-2-cyanoacrylate (NBCA) into the aneurysm are effective for preventing post-EVAR persistent bleeding, in such cases where massive bleeding has impaired coagulation function. 23 ) At our institution, we perform intra-aneurysm embolization using NBCA for cases classified as Fitzgerald III preoperatively or in cases with unstable hemodynamics following stent graft placement ( Fig.…”

Section: Recent Technological Advances In Evarmentioning

confidence: 99%

Recent Advances and Mid-to-Long Term Results of Endovascular Aneurysm Repair for Abdominal Aortic Aneurysms

Morikage

Hamano

2019

Annals of Vascular Diseases

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Endovascular aneurysm repair (EVAR) has become the standard therapy alongside open surgery repair (OSR) for abdominal aortic aneurysm (AAA) and it is rapidly becoming prevalent. There has been substantial technical progress with respect to EVAR since its introduction. Technical contrivance can be used to manage even inappropriate EVAR cases, including those involving a hostile neck, deficient access route, or aneurysm rupture. However, there are some controversies over reinterventions in relation to long-term outcomes. Although a long-term result has not yet been analyzed in Japan a randomized controlled trial (RCT) held in the West reported that OSR is superior to EVAR for avoiding reinterventions and aneurysm-related death. The RCT involved the use of older devices and proceeded in a different way from the present study; therefore, different results may be obtained for Japanese EVAR outcomes. However, this Western RCT result should be considered as an important warning. Type II endoleak also must be managed in order to improve long term outcomes of EVAR. Efforts to improve both technical methodology and long-term outcomes are necessary to ensure EVAR as a minimally invasive therapy for patients with AAA. (This is a translation of Jpn J Vasc Surg 2018; 27: 405–411.)

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Life-Saving Embolization in a Patient with Recurrent Shock Due to a Type II Endoleak after Endovascular Aortic Repair for a Ruptured Abdominal Aortic Aneurysm

Cited by 6 publications

References 10 publications

Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

Endovascular Aneurysm Sac Embolization for Treatment of Ruptured Aneurysms in the Aortoiliac Segment Using N-Butyl-Cyanoacrylate

Recent Advances and Mid-to-Long Term Results of Endovascular Aneurysm Repair for Abdominal Aortic Aneurysms

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