Endoleaks: current concepts and treatments

2021 ◽  
Author(s):  
Zia Ur Rehman
Keyword(s):  
Stent Graft ◽  
Treatment Options ◽  
Endovascular Aneurysm Repair ◽  
Aneurysm Rupture ◽  
Special Situation ◽  
Type V ◽  
Aneurysm Repair ◽  
Benign Course ◽  
Selection Of

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks type 1 and III have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction.  Indirect endoleaks types II, IV and V have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few of them need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. Proper planning and appropriate selection of stent-graft can prevent most of these endoleaks. With improvement in stent-graft technology, the incidence of endoleaks has been reduced. The current narrative review was planned to describe the pathophysiology, risk factors and treatment options for each type of endoleak. Continuous...

Type IIIb Endoleak After Endovascular Aneurysm Repair Using the Zenith Stent Graft

2019 ◽  
Vol 53 (6) ◽  
pp. 515-519
Author(s):  
Toshiya Nishibe ◽  
Toru Iwahashi ◽  
Kentaro Kamiya ◽  
Masaki Kano ◽  
Keita Maruno ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aneurysm Rupture ◽  
Type I ◽  
Stent Grafts ◽  
System Type ◽  
Type Iiib ◽  
Type I Endoleak ◽  
Aneurysm Repair

We present 3 cases of type IIIb endoleak after endovascular aneurysm repair (EVAR) using the Zenith stent graft system. Type III endoleak, like type I endoleak, is a high-pressure, high-risk leak that increases sac pressure up to or even above arterial pressure, and is associated with an increased frequency of open conversions or risk of aneurysm rupture. Type IIIb endoleak is rare but there is much concern that the incidence of type IIIb endoleak is likely to increase hereafter; the mechanism of type IIIb endoleak is deterioration of graft fabric in conjunction with stent sutures. Type IIIb endoleak is difficult to diagnose before rupture. The possibility of type IIIb endoleak should be highly suspected when the continued growth of an excluded aneurysm sac without direct radiologic evidence is observed during follow-up. Type IIIb endoleak can be repaired by relining of the stent graft with additional stent grafts.

scholarly journals Endovascular Aneurysm Repair Using Anaconda Repositionable Aortic Stent Graft Assisted Exclusively by Intravascular Ultrasound Imaging

2019 ◽  
Vol 2 (1) ◽  
pp. 32-37
Author(s):  
Gaetano La Barbera ◽  
Giuliana La Rosa ◽  
Fabrizio Valentino ◽  
Gabriele Ferro ◽  
Dario Parsaei ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Stent Graft ◽  
Clinical Success ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Technique ◽  
Primary Objective ◽  
Aortic Aneurysms ◽  
Aortic Stent Graft ◽  
Aneurysm Repair

Arteriography with contrast medium (CM) injection is normally employed to visualise the lowest renal artery during endovascular aneurysm repair (EVAR). Intravascular ultrasound (IVUS) has been proposed as an alternative, real-time imaging diagnostic technique to arteriography. In this study, we evaluated the feasibility of EVAR using Anaconda repositionable aortic stent graft (Vascutek) assisted by IVUS (Volcano Visions, Philips) during intraluminal navigation without CM. From January 2016 to December 2017, 25 patients with infrarenal abdominal aortic aneurysms, identified through anatomical inclusion criteria, underwent EVAR. All of the patients had an arteriogram at the end of the EVAR procedure to confirm aortic stent graft patency and to exclude type 1 endoleaks. The primary objective was the technical and clinical success of this CM-free aortic stent graft delivery procedure. At the end of the period, 150 target vessels were evaluated. IVUS versus angio-CT sensitivity and specificity rate were 97.3% and 100%, respectively. The primary technical success was obtained in 88% of the cases. Three patients (12%) needed CM injection to complete the procedure and there were no cases of type 1 endoleak. Primary clinical success was 100%. During follow-up at a mean of 20 months, none of the patients died or had complications. We conclude that a full EVAR procedure is feasible using only IVUS navigation and repositionable aortic stent graft without CM injection in anatomically selected cases.

Late Aneurysm Rupture after Repressurization of a Thrombosed Stent-Graft

2007 ◽  
Vol 14 (5) ◽  
pp. 672-675 ◽  
Author(s):  
Philipp Geisbüsch ◽  
Hardy Schumacher ◽  
Jochen Hansmann ◽  
Jens-Rainer Allenberg ◽  
Dittmar Böckler
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Systemic Arterial Pressure ◽  
Aneurysm Rupture ◽  
Graft Occlusion ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
Stent Graft Repair ◽  
Aneurysm Repair ◽  
Endovascular Stent Graft Repair

Purpose: To report late abdominal aortic aneurysm (AAA) rupture after endovascular stent-graft repair despite complete thrombotic stent-graft occlusion. Case Report: A 65-year-old man underwent successful endovascular aneurysm repair (EVAR) with a Stentor device in 1995. In the interim course, the patient developed complete thrombotic stent-graft occlusion, which was treated with an axillobifemoral bypass. After 8 years, the patient presented with a reperfused and ruptured infrarenal AAA. Open repair was performed, with a good clinical result and exclusion of the AAA. Conclusion: Thrombosed stent-grafts and aneurysms can transmit systemic arterial pressure and cause late rupture. Lifelong surveillance is mandatory in EVAR patients.

scholarly journals Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

2018 ◽  
Vol 26 (1) ◽  
pp. 72-75
Author(s):  
Fabien Lareyre ◽  
Claude Mialhe ◽  
Carine Dommerc ◽  
Juliette Raffort
Keyword(s):  
Stent Graft ◽  
Mesenteric Artery ◽  
Endovascular Aneurysm Repair ◽  
Stent Grafts ◽  
Aortic Thrombosis ◽  
Aortic Stent Graft ◽  
Aneurysm Repair ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

Endovascular Abdominal Aortic Aneurysm Repair in Patients with Challenging Anatomy: Utility of the Hybrid Endograft

Vascular ◽  
2004 ◽  
Vol 12 (2) ◽  
pp. 106-113 ◽  
Author(s):  
William D. Jordan ◽  
Thomas C. Naslund ◽  
Mark A. Adelman ◽  
Gene Simoni ◽  
Douglas J. Wirthlin
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Radiographic Evaluation ◽  
Covered Stents ◽  
Aneurysm Size ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Commercially available aortic stent grafts differ in construction and clinical advantage such that creating hybrid endografts by combining components from different manufacturers is sometimes useful. We describe a multicenter experience using hybrid endografts to treat patients with challenging anatomy. Hospital records and office charts were reviewed from four institutions. Hybrid endografts were defined as those with two types of covered stents in continuity to treat an abdominal aortic aneurysm (AAA). Indications for hybrid grafts were defined by type of endoleak and whether an endoleak was expected or unexpected as determined by the preoperative radiographic evaluation. Endpoints include intraoperative endoleaks, late endoleaks, change in aneurysm size, and rupture. Hybrid endografts were used to treat AAA (endovascular aneurysm repair [EVAR]) in 90 patients, representing 7.9% of the total multicenter experience. In 7 patients (7.8%), a hybrid graft construction as a secondary procedure successfully corrected a type 1 endoleak. In the remaining 83 patients (92.2%), hybrid grafts were created at the time of original EVAR to treat expected challenging anatomy or unexpected endoleaks. Hybrid endografts corrected 88 (97.8%) type 1 endoleaks, but 2 patients (2.2%) persisted with a proximal type 1 leak requiring conversion. During follow-up of 1 to 24 months, computed tomography and ultrasound surveillance, available for 73 patients (81.1%), detected one unresolved distal type 1 (1.1%) and seven type 2 (7.8%) endoleaks. Aneurysm size decreased at least 0.5 cm in 23 of 50 patients (46.0%) at 6 months and in 19 of 31 patients (61.3%) at 12 months. Aneurysm size increased at least 0.5 cm in 4 of 50 patients (8.0%) at 6 months and in 1 of 31 patients (3.2%) at 12 months. There were no ruptures. Hybrid endografts have favorable early and intermediate results in the treatment of AAA. Long-term follow-up will be needed to confirm the absence of significant adverse biomaterial interaction and the effect on AAA exclusion. We advocate the use of hybrid endografts as endovascular therapy for patients whose anatomy may be unsuitable for a single endograft type.

Incomplete Expansion of Chimney Stent Graft during Chimney-Thoracic Endovascular Aneurysm Repair

2017 ◽  
Vol 39 ◽  
pp. 293.e1-293.e5 ◽  
Author(s):  
Athanasios Katsargyris ◽  
Domenico Spinelli ◽  
Kyriakos Oikonomou ◽  
Hozan Mufty ◽  
Eric LG. Verhoeven
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Thoracic Endovascular Aneurysm Repair ◽  
Aneurysm Repair

Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: Can we simplify the surveillance protocol and reduce the number of CT scans?

2013 ◽  
Vol 54 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Thomas Nyheim ◽  
Lars Erik Staxrud ◽  
L Rosen ◽  
Carl Erik Slagsvold ◽  
Gunnar Sandbæk ◽  
...  
Keyword(s):  
Stent Graft ◽  
Mixed Model ◽  
Endovascular Aneurysm Repair ◽  
Plain Film ◽  
Ct Scans ◽  
X Rays ◽  
Time Sensitivity ◽  
Surveillance Protocol ◽  
Aneurysm Repair

Background Simplifying a postoperative surveillance protocol for endovascular aneurysm repair (EVAR) requires quality control comparing computerized tomography (CT) and ultrasound (US) results of abdominal aortic aneurysm (AAA) diameter measurements and endoleaks. Purpose To test if US is comparable to CT, then assess a simplified follow-up with our conventional surveillance to assess patient safety. Material and Methods During 2001-2006, data on 56 patients treated with Talent stent graft were prospectively registered. Median follow-up was 41.5 months (range, 2-94 months), with CT, US, and plain film abdomen X-rays (PFA) at 1, 6, and 12 months, then yearly. Bland-Altman plot was used to assess the agreement between CT and US measuring the AAA diameters and mixed model by the time effect to assess the difference in diameter over time. Sensitivity and specificity for detection of endoleaks by US, with CT as ‘gold standard’ were calculated. A simplified surveillance protocol with US/PFA at 6 and 8 weeks, CT/US/PFA at 1 year, and yearly US/PFA thereafter, was evaluated. CT was carried out when poor visibility, endoleak detected, AAA diameter increase (≥5 mm) on US or migration (≥10 mm) on PFA. This regime was compared with our conventional follow-up protocol. Results Diameter measurements on US appear comparable to CT with 91% specificity and 85% sensitivity for endoleaks detected by US. Using the simplified surveillance protocol no endoleaks, migrations, or endotension requiring treatment were overlooked. The simplified protocol generated 53 selective CT scans, avoiding approximately 144 CT scans. If further simplified by omitting the 1-year CT scan, one type II endoleak would be missed with a 1-year delay, eliminating a further 45 CT scans. Conclusion US appears comparable to CT in the follow-up of Talent stent grafts in our institution. The proposed simplified surveillance protocol seems safe and can lead to a significant reduction in the number of CT scans.

Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair

2018 ◽  
Vol 25 (1) ◽  
pp. 21-27 ◽  
Author(s):  
David L. Dawson ◽  
Giuliano de Almeida Sandri ◽  
Emanuel Tenorio ◽  
Gustavo S. Oderich
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Covered Stent ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Flow Divider ◽  
Device Placement ◽  
Internal Iliac ◽  
Aneurysm Repair

Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.

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