Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;28(4):519-523.
doi: 10.1177/15266028211010469. Epub 2021 Apr 26.

Novel Technique for the Treatment of Type Ia Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

Piotr M Kasprzak  1 , Karin Pfister  1 , Waclaw Kuczmik  2 , Wilma Schierling  1 , Georgios Sachsamanis  1 , Kyriakos Oikonomou  1
Affiliations

Novel Technique for the Treatment of Type Ia Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

Piotr M Kasprzak et al. J Endovasc Ther. 2021 Aug.

Abstract

Purpose: Open surgical repair of type Ia endoleak after endovascular aortic aneurysm repair/sealing (EVAR/EVAS) is associated with significant perioperative mortality and morbidity. Current endovascular redo techniques face limitations, especially when the infrarenal landing zone is inadequate and the previous endograft is rigid and features a short or no main body. We present a novel concept for the treatment of type Ia endoleak using a custom-made branched device.

Technique: The 5-branch-device (Cook Medical, Bloomington, IN, USA) consists of a nitinol skeleton with branches, covered with a low-profile polyester fabric loaded in an 18F sheath. The device features a minimum of 2 proximal sealing stents and includes branches for renovisceral vessels as well as an additional 8 mm branch for the contralateral iliac limb. Implantation and sealing in the renovisceral vessels is carried out in standard fashion, using transfemoral and transaxillary access. Distal sealing is achieved by tapering the branched component into the ipsilateral iliac limb and using a bridging balloon-expandable or self-expandable stent-graft through the additional branch to the preexisting contralateral iliac limb.

Conclusion: Treatment of type Ia endoleak with a new custom-made device enables sufficient proximal seal while minimizing suprarenal aortic coverage and facilitates adequate component overlap. The low profile branched design accommodates implantation through the preexisting endograft and catheterization of target vessels.

Keywords: EVAR; EVAS; additional branch; bEVAR; custom-made device; type Ia endoleak.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Piotr M. Kasprzak has received educational grants and is a consultant for Cook Inc, WL Gore & Associates, Bard, Atrium-Maquet, Bentley Innomed, Medtronic and Vascutek. Kyriakos Oikonomou has received educational grants from WL Gore & Associates, Bentley Innomed and is a consultant for Medtronic.

Figures

Figure 1.
Figure 1.
Plan of a tapered, custom-made, low-profile branched device featuring an additional posterior branch (red marking) used for sealing in the contralateral iliac limb.
Figure 2.
Figure 2.
Anterior (A) and posterior (B) view of the custom-made device featuring a branch for the celiac artery (1), a branch for the superior mesenteric artery (2), a branch for the left (3) and right (4) renal artery and a branch for the contralateral iliac limb (5).
Figure 3.
Figure 3.
Intraoperative angiography in anterior view (A) and 3-dimesional reconstruction of a postoperative computed tomography angiography in posterior view (B) of a patient treated with a device featuring an additional iliac limb branch (red marking).
See this image and copyright information in PMC

References

    1. Moulakakis KG, Dalainas I, Mylonas S, et al. Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction. J Endovasc Ther. 2010;17:694–702. - PubMed
    1. Ascoli Marchetti A, Oddi FM, Vacca F, et al. The safety of EVAS surgical conversion in a comparative monocentric analysis. Ann Vasc Surg. 2020;68:310–315. - PubMed
    1. Chen J, Stavropoulos SW. Management of endoleaks. Semin Intervent Radiol. 2015;32:259–264. - PMC - PubMed
    1. Jordan WD, Jr, Mehta M, Varnagy D, et al. Results of the ANCHOR prospective, multicenter registry of EndoAnchors for type Ia endoleaks and endograft migration in patients with challenging anatomy. J Vasc Surg. 2014;60:885–892. - PubMed
    1. Belczak SQ, Pedroso GD, Ogawa LC, et al. Treatment of type 1A endoleak using coil embolization: a case report. J Vasc Bras. 2019;18:e20180130. - PMC - PubMed