Recanalization of previously thrombosed type II endoleak with aneurysm sac expansion after systemic thrombolysis

We present a case of a 72-year-old male with an abdominal aortic aneurysm status post-endovascular aneurysm repair (EVAR). Follow-up imaging demonstrated an enlarging type II endoleak and attempts at transarterial coil embolization of the inferior mesenteric artery were unsuccessful. The patient underwent image-guided percutaneous translumbar type II endoleak repair using XperGuide (Philips, Andover, MA USA).

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Faculty Opinions recommendation of Type II endoleak is an enigmatic and unpredictable marker of worse outcome after endovascular aneurysm repair.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718218160.793489012 ◽

2013 ◽

Author(s):

Norman Hertzer

Keyword(s):

Endovascular Aneurysm Repair ◽

Type Ii ◽

Type Ii Endoleak ◽

Aneurysm Repair

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Prophylactic Aneurysm Embolization During EVAR Is Safe, Improves Sac Regression And Decreases The Incidence Of Type II Endoleak

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.03.015 ◽

2021 ◽

Vol 73 (6) ◽

pp. 2206

Author(s):

A. Mathlouthi ◽

I. Guajardo ◽

O. Al-Nouri ◽

M. Malas ◽

Barleben

Keyword(s):

Type Ii ◽

Type Ii Endoleak ◽

Aneurysm Embolization

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Endovascular treatment of an ilio-iliac arteriovenous fistula accompanied by venous thromboembolism presenting with multiple organ failure – A case report and literature review

Vascular ◽

10.1177/1708538121996576 ◽

2021 ◽

pp. 170853812199657

Author(s):

Tiehao Wang ◽

Jichun Zhao ◽

Ding Yuan

Keyword(s):

Multiple Organ Failure ◽

Arteriovenous Fistula ◽

Organ Failure ◽

Iliac Artery ◽

Vena Cava ◽

Artery Aneurysm ◽

Multiple Organ ◽

High Rate ◽

Type Ii ◽

Type Ii Endoleak

Objectives Multiple organ failure is a rare manifestation of ilio-iliac arteriovenous fistula which can lead to a high rate of misdiagnosis and death. Methods We reported a 61-year-old man presenting with multiple organ failure rapidly after right lower limb swelling. Computed tomography angiography showed an ilio-iliac arteriovenous fistula caused by right common iliac artery aneurysm, and venous thrombosis of bilateral common iliac veins. A bifurcated stent-graft with coil embolization of right internal iliac artery was used for repair. Results The patient recovered rapidly and was discharged without complications. Although arteriovenous fistula persisted due to type II endoleak, aneurysm sac and inferior vena cava significantly shrunk at six months follow-up. Conclusions This report demonstrated that multiple organ failure may appear when the distal outflow tracts of arteriovenous fistula are obstructed. Moreover, endovascular repair is effective for reversal of multiple organ failure caused by arteriovenous fistula, even if arteriovenous fistula persists due to type II endoleak.

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Noninvasive Diagnosis of Incomplete Endovascular Aneurysm Repair: D-Dimer Assay to Detect Type I Endoleaks and Nonshrinking Aneurysms

Journal of Endovascular Therapy ◽

10.1177/152660280200900115 ◽

2002 ◽

Vol 9 (1) ◽

pp. 90-97 ◽

Cited By ~ 16

Author(s):

Francesco Serino ◽

Damiano Abeni ◽

Elisabetta Galvagni ◽

Savino G. Sardella ◽

Alberto Scuro ◽

...

Keyword(s):

Thrombotic Event ◽

Endovascular Aneurysm Repair ◽

Test Group ◽

Type I ◽

Type Ii ◽

Type Ii Endoleak ◽

Blood Samples ◽

Type I Endoleak ◽

D Values ◽

D Dimer

Purpose: To test the hypothesis that D-dimer (D-D), a cross-linked fibrin degradation product of an ongoing thrombotic event, could be a marker for incomplete aneurysm exclusion after endovascular abdominal aortic aneurysm (AAA) repair. Methods: In a multicenter study, 83 venous blood samples were collected from 74 AAA endograft patients and controls. Twenty subjects who were >6 months postimplantation and had evidence of an endoleak and/or an unmodified or increasing AAA sac diameter formed the test group. Controls were 10 nondiseased subjects >65 years old, 18 AAA surgical candidates, and 26 postoperative endograft patients with no endoleak and a shrinking aneurysm. Blood samples were analyzed for D-D through a latex turbidimetric immunoassay. The endograft patients were stratified into 5 clinical groups for analysis: no endoleak and decreasing sac diameter, no endoleak and increasing/unchanged sac diameter, type II endoleak and decreasing sac diameter, type II endoleak and increasing/unchanged sac diameter, and type I endoleak. Results: Individual D-D values were highly variable, but differences among clinical groups were statistically significant (p < 0.0001). D-D values did not vary significantly between patients with stable, untreated AAAs and age-matched controls (238 ± 180 ng/mL versus 421 ± 400 ng/mL, p > 0.05). Median D-D values increased at 4 days postoperatively (963 ng/mL versus 382 ng/mL, p > 0.05) and did not vary thereafter if there was no endoleak and the aneurysm sac decreased. D-D mean values were higher in patients with type I endoleak (1931 ± 924 ng/mL, p < 0.005) and those with unchanged/increasing sac diameters (1272 ± 728 ng/mL) than in cases with decreasing diameters (median 638 ± 238 ng/mL) despite the presence of endoleak (p < 0.0005). Conclusions: Elevated D-D may prove to be a useful marker for fixation problems after endovascular AAA repair and may help rule out type I endoleak, thus excluding patients from unnecessary invasive tests.

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