DOI QR코드

DOI QR Code

Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

  • Choi, Sun-Young (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, University of Yonsei, College of Medicine) ;
  • Won, Jong-Yun (Department of Radiology, Gangnam Severance Hospital, University of Yonsei, College of Medicine) ;
  • Lee, Do-Yun (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, University of Yonsei, College of Medicine) ;
  • Choi, Dong-Hoon (Division of Cardiology, Yonsei Cardiovascular Center and Cardiovascular Research Institute, University of Yonsei, College of Medicine) ;
  • Shim, Won-Heum (Division of Cardiology, Yonsei Cardiovascular Center and Cardiovascular Research Institute, University of Yonsei, College of Medicine) ;
  • Lee, Kwang-Hun (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, University of Yonsei, College of Medicine)
  • Received : 2009.08.06
  • Accepted : 2009.10.30
  • Published : 2010.02.01

Abstract

Objective: The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Materials and Methods: Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Results: Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. Conclusion: The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

Keywords

References

  1. White GH, Yu W, May J, Chaufour X, Stephen MS. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 1997;4:152-168 https://doi.org/10.1583/1074-6218(1997)004<0152:EAACOE>2.0.CO;2
  2. Buth J, Harris PL, van Marrewijk C, Fransen G. The significance and management of different types of endoleaks. Semin Vasc Surg 2003;16:95-102
  3. Baum RA, Carpenter JP, Tuite CM, Velazquez OC, Soulen MC, Barker CF, et al. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms. Radiology 2000;215:409-413 https://doi.org/10.1148/radiology.215.2.r00ma17409
  4. Boks SS, Andhyiswara T, de Smet AA, Vroegindeweij D. Ultrasound-guided percutaneous transabdominal treatment of a type 2 endoleak. Cardiovasc Intervent Radiol 2005;28:526-529 https://doi.org/10.1007/s00270-003-0151-5
  5. Kasthuri RS, Stivaros SM, Gavan D. Percutaneous ultrasound-guided thrombin injection for endoleaks: an alternative. Cardiovasc Intervent Radiol 2005;28:110-112 https://doi.org/10.1007/s00270-004-0149-7
  6. Ellis PK, Kennedy PT, Collins AJ, Blair PH. The use of direct thrombin injection to treat a type II endoleak following endovascular repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol 2003;26:482-484
  7. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004;364:843-848 https://doi.org/10.1016/S0140-6736(04)16979-1
  8. Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004;351:1607-1618 https://doi.org/10.1056/NEJMoa042002
  9. White GH, Yu W, May J. Endoleak--a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg 1996;3:124-125
  10. Sun Z, Mwipatayi BP, Allen YB, Hartley DE, Lawrence-Brown MM. Multislice CT angiography of fenestrated endovascular stent grafting for treating abdominal aortic aneurysms: a pictorial review of the 2D/3D visualizations. Korean J Radiol 2009;10:285-293 https://doi.org/10.3348/kjr.2009.10.3.285
  11. Harris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, van Marrewijk C, Laheij RJ. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on Stent/graft techniques for aortic aneurysm repair. J Vasc Surg 2000;32:739-749 https://doi.org/10.1067/mva.2000.109990
  12. Baum RA, Stavropoulos SW, Fairman RM, Carpenter JP. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 2003;14:1111-1117 https://doi.org/10.1097/01.RVI.0000085773.71254.86
  13. Steinmetz E, Rubin BG, Sanchez LA, Choi ET, Geraghty PJ, Baty J, et al. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J Vasc Surg 2004;39:306-313 https://doi.org/10.1016/j.jvs.2003.10.026
  14. van Marrewijk CJ, Fransen G, Laheij RJ, Harris PL, Buth J; EUROSTAR Collaborators. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg 2004;27:128-137 https://doi.org/10.1016/j.ejvs.2003.10.016
  15. Maldonado TS, Rosen RJ, Rockman CB, Adelman MA, Bajakian D, Jacobowitz GR, et al. Initial successful management of type I endoleak after endovascular aortic aneurysm repair with n-butyl cyanoacrylate adhesive. J Vasc Surg 2003;38:664-670 https://doi.org/10.1016/S0741-5214(03)00729-8
  16. Golzarian J, Maes EB, Sun S. Endoleak: treatment options. Tech Vasc Interv Radiol 2005;8:41-49 https://doi.org/10.1053/j.tvir.2005.06.001
  17. Faries PL, Cadot H, Agarwal G, Kent KC, Hollier LH, Marin ML. Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. J Vasc Surg 2003;37:1155-1161 https://doi.org/10.1016/S0741-5214(03)00084-3
  18. Kasirajan K, Matteson B, Marek JM, Langsfeld M. Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J Vasc Surg 2003;38:61-66 https://doi.org/10.1016/S0741-5214(02)75467-0
  19. LaBerge JM, Sawhney R, Wall SD, Chuter TA, Canto CJ, Wilson MW, et al. Retrograde catheterization of the inferior mesenteric artery to treat endoleaks: anatomic and technical considerations. J Vasc Interv Radiol 2000;11:55-59
  20. van Schie G, Sieunarine K, Holt M, Lawrence-Brown M, Hartley D, Goodman MA, et al. Successful embolization of persistent endoleak from a patent inferior mesenteric artery. J Endovasc Surg 1997;4:312-315 https://doi.org/10.1583/1074-6218(1997)004<0312:SEOPEF>2.0.CO;2
  21. Binkert CA, Alencar H, Singh J, Baum RA. Translumbar type II endoleak repair using angiographic CT. J Vasc Interv Radiol 2006;17:1349-1353 https://doi.org/10.1097/01.RVI.0000231966.74734.7D
  22. Baum RA, Cope C, Fairman RM, Carpenter JP. Translumbar embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 2001;12:111-116 https://doi.org/10.1016/S1051-0443(07)61412-2
  23. Stavropoulos SW, Kim H, Clark TW, Fairman RM, Velazquez O, Carpenter JP. Embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms with use of cyanoacrylate with or without coils. J Vasc Interv Radiol 2005;16:857-861 https://doi.org/10.1097/01.RVI.0000156495.66062.62
  24. van den Berg JC, Nolthenius RP, Casparie JW, Moll FL. CT-guided thrombin injection into aneurysm sac in a patient with endoleak after endovascular abdominal aortic aneurysm repair. AJR Am J Roentgenol 2000;175:1649-1651 https://doi.org/10.2214/ajr.175.6.1751649
  25. Rial R, Serrano Fj F, Vega M, Rodriguez R, Martin A, Mendez J, et al. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: translumbar puncture and injection of thrombin into the aneurysm sac. Eur J Vasc Endovasc Surg 2004;27:333-335 https://doi.org/10.1016/j.ejvs.2003.11.005
  26. Martin ML, Dolmatch BL, Fry PD, Machan LS. Treatment of type II endoleaks with Onyx. J Vasc Interv Radiol 2001;12:629-632 https://doi.org/10.1016/S1051-0443(07)61489-4
  27. Stavropoulos SW, Carpenter JP, Fairman RM, Golden MA, Baum RA. Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol 2003;14:1191-1194 https://doi.org/10.1097/01.RVI.0000085771.71254.14
  28. Mansueto G, Cenzi D, D'Onofrio M, Petrella E, Gumbs AA, Mucelli RP. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: transcaval approach. Cardiovasc Intervent Radiol 2005;28:641-645 https://doi.org/10.1007/s00270-004-0328-6
  29. Kirby L, Goodwin J. Treatment of a primary type IA endoleak with a liquid embolic system under conditions of aortic occlusion. J Vasc Surg 2003;37:456-460 https://doi.org/10.1067/mva.2003.29

Cited by

  1. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis vol.11, pp.6, 2010, https://doi.org/10.3348/kjr.2010.11.6.603
  2. Successful Glue Embolization of a Late Type 1a Endoleak Causing Abdominal Aortic Aneurysm Rupture vol.45, pp.2, 2011, https://doi.org/10.1177/1538574410391821
  3. Anatomical Variations of Lumbar Arteries and Their Clinical Implications: A Cadaveric Study vol.2013, pp.None, 2010, https://doi.org/10.5402/2013/154625
  4. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair vol.13, pp.4, 2010, https://doi.org/10.1590/1677-5449.0110
  5. Percutaneous Interventions in Aortic Disease vol.131, pp.14, 2010, https://doi.org/10.1161/circulationaha.114.006512
  6. Transcatheter Embolization of Type I Endoleaks Associated With Endovascular Abdominal Aortic Aneurysm Repair Using Ethylene Vinyl Alcohol Copolymer vol.51, pp.1, 2017, https://doi.org/10.1177/1538574416687733
  7. The role of ethylene-vinyl alcohol copolymer in association with other embolic agents for the percutaneous and endovascular treatment of type Ia endoleak vol.123, pp.8, 2010, https://doi.org/10.1007/s11547-018-0885-4
  8. Secondary Endoleak Management Following TEVAR and EVAR vol.43, pp.12, 2020, https://doi.org/10.1007/s00270-020-02572-9
  9. Systematic review of embolization of type I endoleaks using liquid embolic agents vol.74, pp.3, 2010, https://doi.org/10.1016/j.jvs.2021.03.061