Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization

Solis, Maurice M.; Ayerdi, Juan; Babcock, Gregory A.; Parra, JosE Roberto Postali; McLafferty, Robert B.; Gruneiro, Laura A.; Ramsey, Don E.; Hodgson, Kim J.

doi:10.1067/mva.2002.126542

Cited by 103 publications

(77 citation statements)

References 30 publications

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“…Transarterial retrograde embolization as well as translumbar embolization was performed for patients with sac enlargement of more than 5 mm, but the technical success rate was not high (17%-44%) because of the presence of a multitude of collateral networks of aortic side branches. [18][19][20] Identification of patients at increased risk of persistent type II endoleak is still imprecise, and the occurrence of various associated adverse events has prompted some interventionists to come to accept that the best method for handling a type II endoleak is to prevent its development in the first place. Muthu, et al reported the findings of their study of routine preoperative embolization of the IMA and thrombin injection into the aneurysm sac.…”

Section: (A) (D) (E) (B) (C)mentioning

confidence: 99%

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

Fukuda

Matsuda

Sanda

et al. 2014

Annals of Vascular Diseases

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Purpose:To identify the computed tomography (CT) findings of persistent type II endoleak from the inferior mesenteric artery (IMA) which indicate the need for preoperative IMA embolization. Materials and Methods: Included were 120 patients (96 males, 49-93 years old, mean: 77.7) who underwent endovascular aortic aneurysm repair (EVAR) between June 2007 and October 2010. The relationship between persistent type II endoleak and CT findings of IMA orifice was examined. Results: CT showed no type II endoleak from IMA in 106 patients (89%; Group N), and transient type II endoleak from IMA in 10 patients (8.3%; Group T). CT showed persistent type II endoleak from IMA in 4 patients (3.3%; Group P) and three of them underwent reintervention. Univariate Cox-Mantel test analysis indicated that stenosis (p = 0.0003) and thrombus (p = 0.043) in IMA orifice were significant factors for persistent type II endoleak. The ratios of patients with proximal IMA more than 2.5 mm diameter in Groups N, Y, and P were 26/106 (24%), 5/10 (50%) and 4/4 (100%), respectively. Conclusion: Indicators for embolization of IMA prior to EVAR for the prevention of type II endoleak appear to be: (1) more than 2.5 mm in diameter and (2) no stenosis due to calcification or mural thrombus in IMA orifice.

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Section: (A) (D) (E) (B) (C)mentioning

confidence: 99%

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

Fukuda

Matsuda

Sanda

et al. 2014

Annals of Vascular Diseases

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“…11,13,14,18-20 Others, however, report a benign clinical course of type II endoleaks. 16, 21 In our study, type II endoleaks were significantly associated with sac growth and reduction.…”

Section: Discussionmentioning

confidence: 69%

Aneurysm Wall Enhancement Detected by Contrast Computed Tomography Scan Is Associated With Aneurysm Shrinkage After Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Ito

Toya

Fukushima

et al. 2018

Circ J

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“…Treatment options include percutaneous transluminal coil embolisation [11], intra-arterial embolisation [12], and-more specifically in the case of IAAs-percutaneous transosseous embolisation [13]. The technique of laparoscopic branch ligation has been suggested as an alternative for the treatment of Type II endoleaks by some experienced investigators [14], particularly in cases of failed embolisation.…”

Section: Discussionmentioning

confidence: 99%

A novel approach to the management of a ruptured Type II endoleak following endovascular repair of an internal iliac artery aneurysm

Patel¹,

Perera²,

Law³

et al. 2011

BJR

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ABSTRACT. Endovascular repair of isolated iliac artery aneurysms is an established safe and effective management option. Type II endoleak is a potential complication, but rarely results in significant morbidity or mortality. We report a case of a patient who presented with a ruptured internal iliac artery aneurysm secondary to a Type II endoleak. To our knowledge this and the following method of managing this have not been previously reported. Established methods of managing endoleaks, such as intravascular transfemoral embolisation and open or laparoscopic ligation, were not possible. Therefore, we resorted to a novel approach to this type of aneurysm and successfully performed a transcutaneous direct puncture and embolisation of the superior gluteal artery. Isolated iliac artery aneurysms (IAAs) are rare, with an incidence rate as low as 0.03% in large autopsy series [1]. These aneurysms represent approximately 2-7% of all intra-abdominal aneurysms [2,3]. Iliac artery dilatation is regarded as aneurismal if it is .25 mm in diameter [4] and repair should be considered for aneurysms greater than 324 cm [3,5]. Over the past decade, endovascular iliac aneurysm repair has been established as a safe and effective alternative to open repair in patients with appropriate anatomy [3,5,6]. A Type II endoleak is one of the complications of endovascular repair and arises due to the persistence of pressurised flow in iliolumbar and sacral arteries. Type II endoleaks are found in up to 20% of cases following endovascular repair [7,8]. Although in most cases Type II endoleaks are considered benign [9], intervention becomes necessary when there is significant expansion of the sac [8] and, subsequently, increased risk of rupture. We report a case of a ruptured IAA secondary to a Type II endoleak and describe a percutaneous technique to embolise the endoleak. To the best of our knowledge, neither has been previously described in relation to an IAA. Case reportAn 84-year-old female presented with a reduced level of consciousness, acute onset abdominal pain and vaginal bleeding for several weeks. Initial assessment revealed that the patient was confused and disorientated, with a Glasgow coma score of 13. The patient was hypotensive (91/49), tachycardic (110) and pyrexial (37.9 u C). Heart sounds were normal, the chest was clear and an abdominal examination revealed tenderness and guarding mostly in the left lower quadrant. Initial investigations revealed haemoglobin (Hb) of 7.7 g dl . Urine dipstick analysis was positive for leukocytes, nitrites, protein and blood. The patient was resuscitated with intravenous (IV) fluids and IV piperacillin and tazobactam was commenced to treat the urinary tract infection. Subsequent urine culture revealed an Enterobacter infection.The patient's medical history included bilateral internal iliac artery aneurysms (IIAAs), chronic renal failure with a left-sided hydronephrosis and ureteric stent in situ, hypertension and ischaemic heart disease. 2 years previously an occlusion of the left IIAA was p...

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Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization

Abstract: PTCE of type II endoleaks has a high failure rate because of multiple anatomic mechanisms.

Cited by 103 publications

References 30 publications

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

Aneurysm Wall Enhancement Detected by Contrast Computed Tomography Scan Is Associated With Aneurysm Shrinkage After Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

A novel approach to the management of a ruptured Type II endoleak following endovascular repair of an internal iliac artery aneurysm

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