AAA Rupture and Psoas Hematoma due to Type II Endoleak from Inferior Mesenteric Artery “Unusual” Collaterals

Theodoridis, Panagiotis G.; Staramos, Dimitrios N.; Ptochis, Nikolaos; Papailiou, Ioannis A.; Dodos, Ilias; Iatrou, Nikolaos; Potouridis, Anastasios; Dervisis, Konstantinos

doi:10.1155/2017/8607437

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…For ruptured AAA cases, any endoleak is equivalent to continuous bleeding, which is not conducive to stable circulation, leading to abdominal compartment syndrome and reducing the success rate of rescue. 14 Thrombin has been used in the treatment of iatrogenic femoral pseudoaneurysm, and its safety and effectiveness has been confirmed. Inspired by this, we applied thrombin injection to the EVAR for ruptured AAA cases.…”

Section: Intra-sac Injection Of Thrombin During Evarmentioning

confidence: 99%

Intra-Sac Injection of Thrombin During Endovascular Aneurysm Repair to Remedy Type II Endoleak and Promote Sac Shrinkage

Zhao,

Xiong,

Luan

et al. 2023

Vasc Endovascular Surg

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Purpose To evaluate the safety and effectiveness of intra-sac thrombin injection to remedy type II endoleaks (T2ELs) during endovascular aneurysm repair (EVAR). Materials and Methods 224 cases abdominal aortic aneurysm (AAA) were treated with EVAR. For the 52 cases of intra-operative type II endoleaks and 8 cases of ruptured AAAs, after the grafts were deployed, thrombin was injected into the aneurysm sac through a preset catheter. The occurrence of endoleaks post-EVAR were followed up with by Computed Tomography (CT) angiogram. The diameter and the volume of the aneurysm sac were also measured. Endpoints included incidence of T2ELs, AAA sac shrinkage and re-intervention rate and all-cause mortality. Results The overall technical success rate was 100%. Fifty-two patients were followed up with for 9-56 (median 24) months. No serious complications were observed during follow-up. The incidence of endoleak was 5.8% (3/52) during follow-up. The maximum diameter of the aneurysm decreased from 61.1 ± 14.2 mm to 53.7 ± 10.6 mm, 47.9 ± 8.3 mm and 43.7 ± 7.2 mm (87.9%, 78.4% and 71.5% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The volume of the aneurysm sac shrank from 236.2 ± 136.2 cm3 to 202.6 ± 114.1 cm3, 155.6 ± 68.4 cm3 and 129.7 ± 52.4 cm3 (85.8%, 65.9%, and 54.9% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The rate of various endoleaks was 5.8% (3/52) and the re-intervention rate was 1.9% (1/52) in this research. Conclusions Clinical outcomes show that intra-sac injection of thrombin during EVAR is safe and may be effective in remedying small amount and low-velocity endoleaks and promoting shrinkage of the aneurysm sac.

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Section: Intra-sac Injection Of Thrombin During Evarmentioning

confidence: 99%

Intra-Sac Injection of Thrombin During Endovascular Aneurysm Repair to Remedy Type II Endoleak and Promote Sac Shrinkage

Zhao,

Xiong,

Luan

et al. 2023

Vasc Endovascular Surg

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“…5 Reintervention for complications after EVAR, such as endoleaks, is performed in about 20% of cases. 7 Type II endoleaks (TIIELs) are the most frequent type of them, with some studies reporting rates as high as 29%, and others as low as 6.3% of the patients treated by EVAR. 8 Type II endoleaks are often benign but have been associated with a higher incidence of aneurysm growth and more secondary endovascular procedures.…”

Section: Introductionmentioning

confidence: 99%

A Late Post-EVAR Rupture in a 102-Year-Old Patient Related to a Type II Endoleak

González-Urquijo

Reijnen

Lozano-Balderas

et al. 2020

Vasc Endovascular Surg

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Purpose: Endovascular abdominal aortic aneurysm repair (EVAR) is progressively being applied in the elderly population. Type II endoleaks are common and mostly benign, but they are related to more aneurysm sac expansion after EVAR. They may lead to rupture in <1% of cases. We present a case of a centenarian with a post-EVAR rupture, related to type II endoleak, and discuss the use of EVAR on the management of this type of endoleak in an extremely old patient. Case Presentation: A 102-year-old man with a history of EVAR 12 years earlier, presented to the emergency department with a drop of consciousness. A computed tomography revealed a ruptured abdominal aortic aneurysm. Angiography showed a type II endoleak related to patent lumbar arteries deriving from collateral branches of the right internal iliac artery. Embolization was not successful and subsequently the ostium of the iliolumbar artery was overstented, obliterating the feeding branch. The postoperative course was complicated by a deterioration of chronic obstructive pulmonary disease and patient was discharged home on the seventh postprocedural day; nonetheless, he died on postoperative day sixteenth due to respiratory complications. Conclusion: Complications following EVAR are a real threat and emphasize the need for follow-up. The current case report shows that age per se should not be a contraindication for EVAR nor for follow-up. Also, late ruptures due to type II endoleaks could be treated in the very elderly population although larger series are required for robust conclusions.

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AAA Rupture and Psoas Hematoma due to Type II Endoleak from Inferior Mesenteric Artery “Unusual” Collaterals

Cited by 2 publications

References 9 publications

Intra-Sac Injection of Thrombin During Endovascular Aneurysm Repair to Remedy Type II Endoleak and Promote Sac Shrinkage

Intra-Sac Injection of Thrombin During Endovascular Aneurysm Repair to Remedy Type II Endoleak and Promote Sac Shrinkage

A Late Post-EVAR Rupture in a 102-Year-Old Patient Related to a Type II Endoleak

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