Contrast ultrasound imaging: the best method to detect type II endoleak during endovascular aneurysm repair follow-up☆

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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Preoperative Inferior Mesenteric Artery Embolization before Endovascular Aneurysm Repair: Decreased Incidence of Type II Endoleak and Aneurysm Sac Enlargement with 24-month Follow-up

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2012.09.022 ◽

2013 ◽

Vol 24 (1) ◽

pp. 49-55 ◽

Cited By ~ 57

Author(s):

Thomas J. Ward ◽

Stuart Cohen ◽

Aaron M. Fischman ◽

Edward Kim ◽

Francis S. Nowakowski ◽

...

Keyword(s):

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Endovascular Aneurysm Repair ◽

Type Ii ◽

Artery Embolization ◽

Type Ii Endoleak ◽

Aneurysm Repair

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An Institution-Wide Algorithm for Treatment of Type II Endoleak Following Endovascular Aneurysm Repair (EVAR)

Vascular and Endovascular Surgery ◽

10.1177/1538574418761269 ◽

2018 ◽

Vol 52 (4) ◽

pp. 249-254 ◽

Cited By ~ 7

Author(s):

Saum Rahimi ◽

Naiem Nassiri ◽

Lauren Huntress ◽

Dustin Crystal ◽

Jones Thomas ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Type Ii ◽

Type Ii Endoleak ◽

Feeding Vessels ◽

Aneurysm Repair ◽

Graft Migration ◽

Embolization Procedure ◽

Definitive Management ◽

Procedure Type

Objectives: Multiple endovascular techniques have been described for the treatment of persistent type II endoleaks (pT2ELs) causing aneurysm sac growth following endovascular aneurysm repair (EVAR). In the event of a failed endovascular procedure and a pT2EL, a consensus regarding further treatment is lacking, and the literature suggests repeated endovascular attempts are rarely successful. Herein, we propose an algorithm for definitive management of pT2ELs with persistent sac growth following EVAR. Methods: A retrospective review of 29 patients who underwent treatment of persistent sac growth in the setting of pT2ELs was performed. Intervention methods were determined at the discretion of the operating surgeon. Aneurysmal sac enlargement was defined as a diameter increase > 5 mm, and persistent endoleak was defined as lasting greater than 6 months. Results: From 2000 to 2015, 917 EVAR procedures were performed at our institution. Isolated pT2ELs with sac enlargement were identified in 29 patients. Twenty-five patients underwent direct translumbar sac puncture and coiling and/or Onyx (Onyx, Plymouth, Minnesota) embolization of the culprit vessels. Thirteen (52%) of 25 patients had pT2EL after first endovascular intervention, and 10 (40%) of 25 patients failed 2 endovascular treatments. Of those 10, 7 displayed persistent aneurysmal sac growth and underwent a third embolization procedure. Type II endoleaks persisted in 6 patients; 3 patients were subsequently treated with laparotomy, ligation of lumbar vessels, sac exploration, and sac plication around the endograft. Technical success for this technique was 100%. During a mean follow-up of 38.4 months, no recurrent T2ELs, stent graft migration, and/or disjunction were observed. Conclusions: We propose a new algorithm for the management of pT2ELs. If 2 endovascular procedures fail to control of the endoleak, repeat endovascular attempts are not recommended. Endovascular failure should be followed by laparotomy with surgical ligation of culprit feeding vessels followed by sac exploration and plication of the sac, and endoaneurysmorrhaphy.

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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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Ischemic Skin Ulceration Complicating Glue Embolization of Type II Endoleak after Endovascular Aneurysm Repair

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2010.10.018 ◽

2011 ◽

Vol 22 (2) ◽

pp. 163-167 ◽

Cited By ~ 10

Author(s):

Marc A. Bailey ◽

Simon J. McPherson ◽

Max A. Troxler ◽

A. Howard S. Peach ◽

Jai V. Patel ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Type Ii ◽

Type Ii Endoleak ◽

Skin Ulceration ◽

Glue Embolization ◽

Aneurysm Repair

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Spinal Cord Ischemia After Endovascular Embolization of a Type II Endoleak Following Endovascular Aneurysm Repair

Annals of Vascular Surgery ◽

10.1016/j.avsg.2011.12.018 ◽

2012 ◽

Vol 26 (6) ◽

pp. 860.e1-860.e7 ◽

Cited By ~ 7

Author(s):

Christos V. Ioannou ◽

Dimitrios K. Tsetis ◽

Dimitrios G. Kardoulas ◽

Pavlos G. Katonis ◽

Asterios N. Katsamouris

Keyword(s):

Spinal Cord ◽

Spinal Cord Ischemia ◽

Endovascular Aneurysm Repair ◽

Endovascular Embolization ◽

Type Ii ◽

Type Ii Endoleak ◽

Aneurysm Repair

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Comparing polymer-filled versus self-expanding endografts in Chinese patients

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318810108 ◽

2018 ◽

Vol 26 (9) ◽

pp. 667-676

Author(s):

Yuk Law ◽

Yiu Che Chan ◽

Stephen Wing-Keung Cheng

Keyword(s):

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

The Self ◽

Chinese Patients ◽

Type Ii ◽

Mortality And Morbidity ◽

Type Ia ◽

One Year ◽

Aneurysm Repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

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