Abstract No. 442 Femoral flip: reversible femoral access

Abstract

Purpose: Thoracic endovascular aortic repair (TEVAR) has supplanted open repair of thoracic aortic pathology in many patients. As with abdominal endovascular aortic repair (EVAR), endoleak is a potential complication that could allow progressive enlargement of the excluded lumen with risk of rupture. While there is substantial literature on endoleak embolization in the setting of EVAR for abdominal aortic aneurysms, there have been only several case reports on endoleak embolization in TEVAR patients. The purpose of this study was to report outcomes after embolization for the management of endoleak after TEVAR. Materials: Retrospective review of the interventional radiology database for patients undergoing percutaneous transcatheter embolization of endoleak after TEVAR over a 14-year period revealed 24 patients (13 female, average age 65.8 years). Endoleak types were categorized as type 1A (n¼15), type 1B (n¼3), and type 2 (n¼11). The endoleak cavity was accessed transarterially or via direct transmediastinal puncture. Embolic agents included coils (n¼21 patients), liquid embolic (n¼12), and vascular plugs (n¼5 patients). Patients underwent clinical follow up and contrastenhanced CTA every 6-12 months indefinitely. Technical success was defined as deployment of embolic material within the endoleak sac. Clinical success was defined as disappearance of the endoleak on follow up CTA with stable or decreased endoleak sac size. Results: Technical success was achieved in all cases. No major complications were encountered related to the procedure. Twenty patients had imaging follow up. Clinical success was achieved in 15 (75%). A persistent endoleak was demonstrated in 5 patients (25%), with further enlargement of the excluded sac in 2 patients. No cases of aortic rupture were encountered. No difference was identified in clinical success between endoleak types (p¼1). Clinical success was achieved in 10 of 11 patients (91%) who underwent embolization with liquid embolic versus 9 of 13 (69%) who did not receive liquid embolic (p¼0.3). Conclusions: Percutaneous embolization of endoleak after TEVAR is safe with a clinical success rate of 75%, which may serve to minimize the likelihood of future rupture.