The Use of Direct Thrombin Injection to Treat a Type II Endoleak Following Endovascular Repair of Abdominal Aortic Aneurysm

Abstract

This report describes the use of thrombin to treat a type II endoleak which was causing continued abdominal aortic aneurysm expansion in a patient who had undergone endovascular repair. A small quantity of thrombin was injected into the leak by a percutaneous approach directly into the aneurysm sac using color doppler ultrasound. The procedure was successful and required only a few minutes to perform. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.

A ruptured aneurysm after stent graft puncture during computed tomography-guided thrombin injection

“…9,10,15 To the best of our knowledge, we are the first to report rupture of an aneurysm due to an iatrogenic type III endoleak from a puncture of the endograft during a CT-guided thrombin injection. Although CT provides excellent needle visualization, and direction and depth can be visualized, it remains a procedure that has to be thoughtfully planned and executed.…”

“…If intervention is necessary, however, thrombin injection has proven to be an effective method of treatment of a type II endoleak. [9][10][11][12]15,17 This case clearly shows a potential negative adverse effect of this procedure.…”

“…Furthermore, an ultrasound-guided puncture is operator-dependent and has a relatively long learning curve. 10,11 A good alternative is therefore fluoroscopy combined with CTA. CT can verify needle positioning, and fluoroscopic guidance allows realtime embolization, thereby preventing misplacement of the needle or any embolic material.…”

Detection of Occult Endoleaks After Endovascular Treatment of Abdominal Aortic Aneurysm Using Magnetic Resonance Imaging With a Blood Pool Contrast Agent

“…6 Ultrasound or CT-guided thrombin injection into the region of an endoleak has been reported as a treatment strategy for patients with growing aneurysms and type II endoleaks detected with CTA or ultrasound. [23][24][25] By detecting and localizing endoleaks that are occult on CT, MRI with a blood pool contrast agent could be used to guide thrombin injection in patients who have not previously been considered candidates for this treatment.…”

What is the significance of endoleaks and endotension

“…A lower recurrence rate can be achieved if the entire aneurysm sac is glue-or coil-embolized [69]. Also, thrombin injection into the leak by a percutaneous approach directly into the aneurysm sac using Doppler US has been described [70]. A more effective, but also more invasive, treatment method is feeding vessel ligation or clipping, which can be performed using laparoscopy or laparotomy [71][72][73][74].…”