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. 2021 Feb;126(2):258-263.
doi: 10.1007/s11547-020-01247-2. Epub 2020 Jul 13.

Direct percutaneous embolization of aneurysm sac: a safe and effective procedure to treat post-EVAR type II endoleaks

Fabrizio Fanelli #  1 , Alessandro Cannavale #  2 , Emiliano Chisci  3 , Michele Citone  1 , Gian Marco Falcone  1 , Stefano Michelagnoli  3 , Vittorio Miele  4
Affiliations

Direct percutaneous embolization of aneurysm sac: a safe and effective procedure to treat post-EVAR type II endoleaks

Fabrizio Fanelli et al. Radiol Med. 2021 Feb.

Abstract

Purpose: To report safety and effectiveness of type II endoleak embolization, with percutaneous direct aneurysm sac puncture.

Materials and methods: Fifty patients, 31 male (mean age 55 ± 5), with post-EVAR type-II endoleak underwent direct percutaneous sac puncture for embolization. Procedures were performed, under local anesthesia. Sac puncture was done using a 20G needle under rotational angiography guidance. A coaxial system (4 Fr catheter + 2.7 microcatheter) was used to navigate the sac. During the follow-up period, all patients underwent contrast-enhanced ultrasound (CEUS) at 6 and 12 months.

Results: Technical success, with complete exclusion of the aneurysm sac, was achieved in all cases. Time of procedure varied between 36 and 68 min (mean 51.36 min). Mean fluoroscopy time was 16.7 min. A posterior left access was used in 41 cases, posterior right access in 6 cases, and an anterior approach in 3. In 19 cases (38%), one or more feeding vessels were visualized and embolized. Sac embolization was done using Onyx plus micro-coils in 31 cases (62%) and Onyx alone in 19 cases (38%). Mean amount of Onyx was 6 ml. No complications, correlated with the direct percutaneous sac puncture, or to Onyx injection occurred. After 1-year follow-up, sac shrinkage occurred in 34 cases (68%), while in 16 patients (32%) sac size remained stable without evidence of sac perfusion.

Conclusion: Percutaneous direct sac embolization using Onyx in combination or not with microcoils represents a safe and valid technique to solve post-EVAR type II endoleaks.

Keywords: Abdominal aortic aneurysm; Angiography; Embolization; Endoleak; Onyx.

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References

    1. Chaikof EL, Dalman RL, Eskandari MK et al (2018) The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 67:2–77.e2. https://doi.org/10.1016/j.jvs.2017.10.044 - DOI - PubMed
    1. Ultee KHJ, Büttner S, Huurman R et al (2018) Editor's choice—systematic review and meta-analysis of the outcome of treatment for type II endoleak following endovascular aneurysm repair. Eur J Vasc Endovasc Surg 56:794–807. https://doi.org/10.1016/j.ejvs.2018.06.009 - DOI - PubMed
    1. Rand T, Uberoi R, Cil B et al (2013) Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Intervent Radiol 36:35–45. https://doi.org/10.1007/s00270-012-0439-4 - DOI - PubMed
    1. Bryce Y, Lam CK, Ganguli S et al (2018) Step-by-step approach to management of type II endoleaks. Tech Vasc Interv Radiol 21:188–195. https://doi.org/10.1053/j.tvir.2018.06.009 - DOI - PubMed
    1. Spanos K, Tsilimparis N, Larena-Avellaneda A et al (2017) Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 66:1878–1884 - DOI

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