Transabdominal Direct Sac Puncture Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair

Zener, Rebecca; Oreopoulos, George; Beecroft, R.; Rajan, Dheeraj K.; Jaskolka, Jeffrey D.; Tan, Kong Teng

doi:10.1016/j.jvir.2018.04.002

Cited by 36 publications

(31 citation statements)

References 27 publications

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“…This involves the direct percutaneous puncture of the aneurysm sac. It is most commonly performed via a translumbar approach with the patient positioned prone on the operating table but may also be performed transabdominally [ 56 ] when there is an anterior endoleak. It can be performed under general anaesthesia, or under sedation and local anaesthesia, depending on the patient and the potential difficulty of the procedure.…”

Section: Management Of Secondary Endoleaks—evarmentioning

confidence: 99%

“…Outcomes of Direct Sac Puncture Embolisation: There are only two papers that have specifically reported the outcomes of direct sac puncture embolisation [ 56 , 57 ]. In the larger of these studies, Zener et al (2018) reported on 33 transabdominal embolisations in 30 patients using a range of embolic agents with a technical success rate of 97% and clinical success of 85%, defined as freedom from sac growth (Table 4 ).…”

Section: Management Of Secondary Endoleaks—evarmentioning

confidence: 99%

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Secondary Endoleak Management Following TEVAR and EVAR

Ameli-Renani

Pavlidis

Morgan

2020

Cardiovasc Intervent Radiol

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Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types.

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Section: Management Of Secondary Endoleaks—evarmentioning

confidence: 99%

Section: Management Of Secondary Endoleaks—evarmentioning

confidence: 99%

Secondary Endoleak Management Following TEVAR and EVAR

Ameli-Renani

Pavlidis

Morgan

2020

Cardiovasc Intervent Radiol

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“…The indication for treatment typically includes persistent endoleak (> 6 months) and continued sac expansion (> 0.5 cm) (Yamada et al, 2015; Ozdemir et al, 2013). Frequently used strategies include: 1) transarterial embolization of the feeding vessel accessed from the superior mesenteric or internal iliac artery collaterals; and 2) embolization via direct sac puncture from a translumbar (Ozdemir et al, 2013) or transabdominal (Zener et al, 2018) approach. The surgical options include ligation of the source vessels laparoscopically or open repair with feeding vessel ligation and aneurysmorraphy (Scali et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Transcaval approach for embolization of type II Endoleak following endovascular aortic aneurysm repair

et al. 2019

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Type II endoleak is a common complication following endovascular aortic aneurysm repair and can lead to an increased risk of aneurysmal expansion and rupture. The most frequently employed strategies to treat Type II endoleak involves catheterization of the branch vessels responsible for the endoleak or accessing the aneurysm sac through a percutaneous approach. An endovascular transcaval approach for embolization of the aneurysmal sac provides an alternate strategy with comparable success rates. This technique is advantageous when the endoleak is predominantly on the right side of the aneurysm sac and/or when a direct access to the aneurysm sac through a percutaneous approach is not feasible.

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“…In this case, we performed transabdominal direct puncture embolization because the patient presented again with type II endoleak after transarterial embolization and his endoleak was anatomically suitable for a transabdominal approach. Our institution is experienced with transabdominal embolizations, having performed 33 for type II endoleak between 2011 and 2016 with a technical success rate of 97% 10 …”

Section: Discussionmentioning

confidence: 99%

“…The benefits of transabdominal embolization over a translumbar technique include better toleration of surgery with supine positioning and easier cannulation of lumbar artery origins 10 . A transcaval approach may have lowered the probability of bowel injury, but it presents unique risks, including inadvertent intracaval embolization and aortocaval fistula 11 .…”

Section: Discussionmentioning

confidence: 99%

Aortic graft infection with enteric organism after embolization of late type II endoleak

Tan

MacDonald

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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An 82-year-old man with a history of endovascular repair for ruptured abdominal aortic aneurysm 6 years ago presented with a type II endoleak and enlarging sac. He had successful transabdominal direct sac puncture embolization but developed fever 2 days postoperatively. Contrast-enhanced computed tomography showed a rim-enhancing collection, and sac aspiration was positive for enteric organisms, confirming endograft infection. The patient underwent graft explantation and neoaortic reconstruction using superficial femoral veins. Three months postoperatively, computed tomography showed complete resolution of fluid collection and no signs of graft infection. This report illustrates direct puncture embolization complicated by endograft infection from enteric bacteria.

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Transabdominal Direct Sac Puncture Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair

Cited by 36 publications

References 27 publications

Secondary Endoleak Management Following TEVAR and EVAR

Secondary Endoleak Management Following TEVAR and EVAR

Transcaval approach for embolization of type II Endoleak following endovascular aortic aneurysm repair

Aortic graft infection with enteric organism after embolization of late type II endoleak

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