Embolization for Type Ia Endoleak after EVAR for Abdominal Aortic Aneurysms: A Systematic Review of the Literature

Abstract

(1) Successful endovascular repair for abdominal aortic aneurysms is based on the complete exclusion of the aneurysm sac from the systemic circulation. Type Ia endoleak (ELIA) is defined as the persistent perfusion of the aneurysm sac due to incomplete proximal sealing between aorta and endograft, with a consequent risk of rupture and death. Endoleak embolization has been sporadically reported as a viable treatment for ELIA. (2) A systematic literature search in PubMed of all publications in English about ELIA embolization was performed until February 2022. Research methods and reporting were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data regarding patient numbers, technical success (endoleak absence at control angiography), reinterventions, clinical and imaging follow-up, and outcomes were collected and examined by two independent authors. (3) Twenty-one papers (12 original articles, 9 case reports) reported on 126 patients (age range 58–96 years) undergoing ELIA embolization 0–139 months after the index procedure. Indication for embolization was most often founded on unfavorable anatomy and patient comorbidities. Embolic agents used include liquid embolic agents, coils, plugs and combinations thereof. Technical success in this highly selected cohort ranged from 67–100%; the postprocedural complication rate within 30 days was 0–24%. ELIA recurrence was reported as 0–42.8%, with a secondary ELIA-embolization-intervention success rate of 50–100%. At a follow-up at 0–68 months, freedom from sac enlargement amounted to 76–100%, freedom from ELIA to 66.7–100%. (4) Specific literature about ELIA embolization is scant. ELIA embolization is a valuable bailout strategy for no-option patients; the immediate technical success rate is high and midterm and long-term outcomes are acceptable.

Type IIIb Endoleak: The Great “Masquerader” - Risks of Liquid Agent Dislocation During Sac Embolization Techniques

“…7 Liquid embolic dislocation occurred in up to 9% of the patients, though no case of intraluminal graft spillage was recorded. 7 Type Ia endoleak Embolization techniques and in particular the controlled release of both coils and liquid embolic agents may be technically challenging. The objective of combining liquid embolic agents and coils for endoleak embolization is to increase embolizing power while maintaining safety.…”

“…7 Liquid embolic dislocation occurred in up to 9% of the patients, though no case of intraluminal graft spillage was recorded. 7…”

“…7 The use of coils and liquid embolic agents was the primary embolic agent used, alone or in combination; and a high technical success rate was reported (67 to 100%), while the overall complication rate was low (0-24%). 7 Liquid embolic dislocation occurred in up to 9% of the patients, though no case of intraluminal graft spillage was recorded. 7 Type Ia endoleak Embolization techniques and in particular the controlled release of both coils and liquid embolic agents may be technically challenging.…”

“…A recent systematic review identified 126 patients with delayed type Ia endoleaks treated with embolization techniques (derived from 21 case series and case reports). 7 The use of coils and liquid embolic agents was the primary embolic agent used, alone or in combination; and a high technical success rate was reported (67 to 100%), while the overall complication rate was low (0-24%). 7 Liquid embolic dislocation occurred in up to 9% of the patients, though no case of intraluminal graft spillage was recorded.…”