Abstract
An 80-year-old female underwent EVAR 4 years ago. She presented type II endoleak with sac expansion from 68 to 80 mm during 3-year follow-up after EVAR. Although she underwent translumbar percutaneous sac embolization, the AAA sac continued to enlarge, suggesting mixed-type endoleak including type I, II, and III. Transgraft direct sac angiography revealed endoleak cavity without demonstrable feeding vessel. Transgraft sac embolization using n-butyl cyanoacrylate and graft reinforcement was performed concurrently, without complications. The graft reinforcement consisted of graft extension for eliminating occult type I endoleak, and relining for eliminating occult type III endoleak. Six months after the procedure, CT showed no signs of sac expansion. Transgraft sac embolization combined with graft reinforcement is one of the available options for persistent and refractory mixed-type endoleak.
Similar content being viewed by others
References
Nevala T, Biancari F, Manninen H, et al. Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Interv Radiol. 2010;33:278–84.
Stavropoulos SW, Kim H, Clark TW, Fairman RM, Velazquez O, Carpenter JP. Embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms with use of cyanoacrylate with or without coils. J Vasc Interv Radiol. 2005;16:857–61.
Stavropoulos SW, Park J, Fairman R, Carpenter J. Type 2 endoleak embolization comparison: translumbar embolization versus modified transarterial embolization. J Vasc Interv Radiol. 2009;20:1299–302.
Uthoff H, Katzen BT, Gandhi R, Peña CS, Benenati JF, Geisbüsch P. Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg. 2012;56:965–72.
Abouliatim I, Gouicem D, Kobeiter H, Majeski M, Becquemin JP. Early type III endoleak with an Endurant endograft. J Vasc Surg. 2010;52(6):1665–7.
Naughton PA, Garcia-Toca M, Rodriguez HE, et al. Endovascular treatment of delayed type 1 and 3 endoleaks. Cardiovasc Interv Radiol. 2011;34:751–7.
Klonaris C, Georgopoulos S, Markatis F, Katsargyris A, Tsigris C, Bastounis E. Endovascular repair of late abdominal aortic aneurysm rupture owing to mixed-type endoleak following endovascular abdominal aortic aneurysm repair. Vascular. 2007;15(3):167–71.
Theodoridis PG, Staramos DN, Ptochis N, et al. Combined type III and type II endoleaks after endovascular aneurysm repair: presentation of 2 cases and a literature review. Ann Vasc Surg. 2018. https://doi.org/10.1016/j.avsg.2018.06.028.
Avgerinos KI, Melas N, Saratzis A, Tympanidou MV, Saratzis N, Lazaridis I. Endovascular repair for a ruptured AAA due to a combined type IIIb and Ia endoleak. Case Rep Vasc Med. 2018;24:1502328.
Mewissen MW, Jan MF, Kuten D, Krajcer Z. Laser-assisted transgraft embolization: a Technique for the treatment of type II endoleaks. J Vasc Interv Radiol. 2017;28:1600–3.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Consent for Publication
Consent for publication was obtained for person’s data included in the study.
Human and Animal Participants
This procedure performed in study involving human participant was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from the participant included in the study.
Rights and permissions
About this article
Cite this article
Nakai, M., Ikoma, A., Loffroy, R. et al. Transgraft sac Embolization Combined with Graft Reinforcement for Refractory Mixed-Type Endoleak. Cardiovasc Intervent Radiol 42, 620–624 (2019). https://doi.org/10.1007/s00270-018-2144-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-018-2144-4