Secondary Endoleak Management Following TEVAR and EVAR

Ameli-Renani, Seyed; Pavlidis, Vyzantios; Morgan, Robert

doi:10.1007/s00270-020-02572-9

Cited by 52 publications

(78 citation statements)

References 89 publications

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“…Among the different NALEA for E2, Onyx is the most widely used followed by Squid. Recently, a case report describing a successful embolization of E2 using Phil has also been published [ 46 , 55 ] with similar results…”

Section: Endoleakmentioning

confidence: 68%

“…The most common complication is represented by endoleaks, which may compromise long-term endograft viability, increasing the risk of rupture; therefore, long-term surveillance is needed and in specific cases secondary interventions are requested [ 45 ]. Endoleaks are classified on the basis of anatomical origin, among different types: Types I and II are the most common, and are usually treated through an endovascular procedure [ 46 ]. Nowadays, a surgical approach is performed only in cases of endovascular that are unsuccessful or a fast sac growth with a high risk of rupture.…”

Section: Endoleakmentioning

confidence: 99%

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Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Piacentino

Fontana

Curti

et al. 2021

JCM

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This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.

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Section: Endoleakmentioning

confidence: 68%

Section: Endoleakmentioning

confidence: 99%

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Piacentino

Fontana

Curti

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…They are caused by retrograde blood flow into the sac from branches of the endograft covered native aorta or iliac vessels. There is usually one dominant inflow artery, most commonly the IMA or a lumbar artery, and often one or more outflow arteries [8] . T2EL are inherently low flow and are often transient, resolving following thrombosis of the aneurysm sac and reversal of anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…In practice, procedural success is limited by difficulty in accessing the paraendograft space and accessing the endoleak nidus even when the sac thrombus has been accessed. Embolization of the sac thrombus if the nidus cannot be accessed is of no benefit [8] , [19] , [20] . In this regard, it was beneficial in trans-limb embolization, the use of Concerto Helix Detachable Coil System (Medtronic, Inc., Minneapolis, MN, US).…”

Section: Discussionmentioning

confidence: 99%

Trans-limb embolization for treatment of Type 2 endoleak post EVAR: Case report

Dinoto

Ferlito

Urso

et al. 2021

International Journal of Surgery Case Reports

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Introduction Type 2 endoleaks (T2EL) occur after 10%–25% of endovascular abdominal aortic aneurysm repairs and increase the risk factor of endograft repair failure and rupture. Herein we report a case of endovascular treatment of T2EL where we performed a trans-limb embolization. Presentation of case A 63-years-old male previously treated for AAA with endovascular aortic aneurysms repair (EVAR), showed an angio-CT scan followup with a type 2 endoleak fed from inferior mesenteric artery (AMI) with growth of AAA greater of 1 cm than preoperative CT-scan and increase of chronic lumbar pain. Due to high risk of rupture was performed a trans-limb embolization with complete sealing. The 6 months CT-angiography showed complete type 2 endoleak exclusion without changes of AAA. Discussion The risk of aneurysm rupture in the presence of an isolated T2EL is exceptionally low. However, when a persistent T2EL is associated with a significant sac size increase, commonly considered as at least 5 mm over 6 months, should be treated. Detachable coils are repositionable, allowing an extremely precise deployment and subsequent embolization of different targets. Conclusion In this experience trans-limb embolization was feasible and this tool should be taken in account especially when no other surgical options exists.

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“…In addition, OSR is a remedy when EVAR fails or causes comorbidities. For instance, OSR is a selection of prompt treatment to secondary endoleak following EVAR and TEVAR [ 7 ]. Since OSR has high efficacy but still with problems in safety simultaneously, the prognosis of it is still worthy of enough consideration.…”

Section: Introductionmentioning

confidence: 99%

Association between anion gap and mortality of aortic aneurysm in intensive care unit after open surgery

Gao¹,

Hong

Shen

et al. 2021

BMC Cardiovasc Disord

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Background There has not been a well-accepted prognostic model to predict the mortality of aortic aneurysm patients in intensive care unit after open surgery repair. Otherwise, our previous study found that anion gap was a prognosis factor for aortic aneurysm patients. Therefore, we wanted to investigate the relationship between anion gap and mortality of aortic aneurysm patients in intensive care unit after open surgery repair. Methods From Medical Information Mart for Intensive Care III, data of aortic aneurysm patients in intensive care unit after open surgery were enrolled. The primary clinical outcome was defined as death in intensive care unit. Univariate analysis was conducted to compare the baseline data in different groups stratified by clinical outcome or by anion gap level. Restricted cubic spline was drawn to find out the association between anion gap level and mortality. Subgroup analysis was then conducted to show the association in different level and was presented as frost plot. Multivariate regression models were built based on anion gap and were adjusted by admission information, severity score, complication, operation and laboratory indicators. Receiver operating characteristic curves were drawn to compare the prognosis ability of anion gap and simplified acute physiology score II. Decision curve analysis was finally conducted to indicate the net benefit of the models. Results A total of 405 aortic aneurysm patients were enrolled in this study and the in-intensive-care-unit (in-ICU) mortality was 6.9%. Univariate analysis showed that elevated anion gap was associated with high mortality (P value < 0.001), and restricted cubic spline analysis showed the positive correlation between anion gap and mortality. Receiver operating characteristic curve showed that the mortality predictive ability of anion gap approached that of simplified acute physiology score II and even performed better in predicting in-hospital mortality (P value < 0.05). Moreover, models based on anion gap showed that 1 mEq/L increase of anion gap improved up to 42.3% (95% confidence interval 28.5–59.8%) risk of death. Conclusions The level of serum anion gap was an important prognosis factor for aortic aneurysm mortality in intensive care unit after open surgery.

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Secondary Endoleak Management Following TEVAR and EVAR

Cited by 52 publications

References 89 publications

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Trans-limb embolization for treatment of Type 2 endoleak post EVAR: Case report

Association between anion gap and mortality of aortic aneurysm in intensive care unit after open surgery

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