Surgical treatment of the progressive endoleak type II after EVAR

Dobeš, Daniel; Hájek, M; Raupach, Jan; Bëlobrádek, Z; Kuriakose, John; Arestis, Nikolas J.

doi:10.1007/s10353-016-0409-1

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…The laparoscopic procedure of clipping IMA and LAs is a relatively safe option from peritoneal or retroperitoneal points of view with good results, and is a minimally invasive approach, which indicates the best individual treatment for each patient to prevent complications after EVAR. Open endoaneurysmorrhaphy [34,35] is another treatment for patients where the previously described treatment is not successful and there are difficulties using a laparoscopic method. The risks are low where the patient is relatively fit for the intervention and an experienced team can prevent misplacement of the SG to minimize blood loss without an aortic clamp.…”

Section: Discussionmentioning

confidence: 99%

“…A very good alternative is to have an occlusion balloon in the aorta close to the origin of the renal arteries to be ready for the eventual leak from the neck area. The main step of the procedure is an incision of the aortic sac and endoaneurysmorrhaphy (suture of LA origins from inside the sac), then the suture of the aortic sac is tightened (in two layers is a good option) around the SG in situ [34,35] (Figures 5 and 6). It is very important to protect the SG against a misplacement.…”

Section: Open Transperitoneal Approachmentioning

confidence: 99%

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Treatment of the Progressive Endoleak Type 2 After EVAR

Dobeš¹

2019

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice

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An endoleak type 2 (EL2) is a relatively frequent event after an EVAR but 30-35% of EL2 can become progressive, which can cause a loss in the important sealing zone of the stent graft. Diagnosis is made by three-phase CT angiogram or by contrast-enhanced duplex scan. EL2 should be treated if the aortic sac grows more than 5 mm in 6 months time. The first suitable treatment is the endovascular approach with embolization of the inferior mesenteric artery (IMA) or lumbar arteries. Paravertebral puncture, under CT navigation to embolize the lumbar artery or a part of the aortic sac with the EL2, is another alternative. If the endovascular treatment is not successful in 2-3 times, we should consider a surgical approach. The operative approach can be a laparoscopic or an open operation: the laparoscopic approach allows us to clip the IMA and lumbar arteries. The open surgery involves laparotomy, ligation of the IMA, and endoaneurysmorrhaphy (suture of lumbar artery origins from inside) and then the suture of the aortic sac tightly around the stent graft in situ. The aortic occlusion balloon should be inserted below the renal arteries prior to open surgery. The surgical procedures have good outcomes and should be considered when the endovascular treatment is unsuccessful.

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Section: Discussionmentioning

confidence: 99%

Section: Open Transperitoneal Approachmentioning

confidence: 99%

Treatment of the Progressive Endoleak Type 2 After EVAR

Dobeš¹

2019

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice

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“…Years of experience with EVAR have led to the development of new generations of SG and a signi cant reduction in the incidence of complications (3). Thus, EL remains as the most common complication of EVAR today, often requiring further endovascular or surgical reintervention (4,5).…”

Section: Introductionmentioning

confidence: 99%

Complex Endoleak Treatment After Failed Endovascular Aortic Repair

Raupach

Masek

Venugopal

et al. 2023

Preprint

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Background Endovascular aneurysm repair (EVAR) has created new possibilities for patients with abdominal aortic aneurysms (AAAs), and in recent years it has become tremendously popular. Use of EVAR in selected groups of patients allows mortality and morbidity to be reduced in comparison to open repair. However, complications such as endoleaks (ELs) can be of great concern and warrant urgent therapy to prevent sac rupture. Case Presentation The case report presents urgent endovascular treatment of a high-risk type IA EL in a polymorbid 68-year-old patient 7 years after primary EVAR. The principle of treatment was parallel implantation of the proximal SG extension with the renal SG into the right renal artery (chimney technique). The subsequent type II collateral EL was treated by direct transabdominal AAA sac puncture and thrombin embolization. Conclusion EL can be a cause for urgent intervention, but specific anatomic features often require specialized SG types which are not readily available. The chimney technique allows the use of immediately available stent grafts to address endoleak in the setting of impending abdominal aneurysm rupture.

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“…Years of experience with EVAR have led to the development of new generations of SG and a significant reduction in the incidence of complications [ 3 ]. Thus, EL remains as the most common complication of EVAR today, often requiring further endovascular or surgical reintervention [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Complex endoleak treatment after failed endovascular aortic repair

Raupach,

Masek,

Venugopal

et al. 2023

CVIR Endovasc

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Background Endovascular aneurysm repair (EVAR) has created new possibilities for patients with abdominal aortic aneurysms (AAAs), and in recent years it has become tremendously popular. Use of EVAR in selected groups of patients allows mortality and morbidity to be reduced in comparison to open repair. However, complications such as endoleaks (ELs) can be of great concern and warrant urgent therapy to prevent sac rupture. Case presentation The case report presents urgent endovascular treatment of a high-risk type IA EL in a polymorbid 68-year-old patient 7 years after primary EVAR. The principle of treatment was parallel implantation of the proximal SG extension with the renal SG into the right renal artery (chimney technique). The subsequent type II collateral EL was treated by direct transabdominal AAA sac puncture and thrombin embolization. Conclusion EL can be a cause for urgent intervention, but specific anatomic features often require specialized SG types which are not readily available. The chimney technique allows the use of immediately available stent grafts to address endoleak in the setting of impending abdominal aneurysm rupture.

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Surgical treatment of the progressive endoleak type II after EVAR

Cited by 5 publications

References 5 publications

Treatment of the Progressive Endoleak Type 2 After EVAR

Treatment of the Progressive Endoleak Type 2 After EVAR

Complex Endoleak Treatment After Failed Endovascular Aortic Repair

Complex endoleak treatment after failed endovascular aortic repair

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