Type II endoleaks Journal of Vascular Surgery

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Presentation transcript:

Type II endoleaks Journal of Vascular Surgery Efthymios D. Avgerinos, MD, Rabih A. Chaer, MD, Michel S. Makaroun, MD Journal of Vascular Surgery Volume 60, Issue 5, Pages 1386-1391 (November 2014) DOI: 10.1016/j.jvs.2014.07.100 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 After endovascular aneurysm repair (EVAR), the abdominal aortic aneurysm can shrink despite the presence of a type II endoleak, which may otherwise show late spontaneous resolution. a, Type II endoleak at year 1. b, Persistent type II endoleak at year 2 with sac shrinkage. c, No endoleak and aneurysm continues to shrink at year 3. Journal of Vascular Surgery 2014 60, 1386-1391DOI: (10.1016/j.jvs.2014.07.100) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Algorithm of type II endoleak management. CEUS, Contrast-enhanced ultrasound; DUS, duplex ultrasound; EVAR, endovascular aneurysm repair; MRA, magnetic resonance angiography. Journal of Vascular Surgery 2014 60, 1386-1391DOI: (10.1016/j.jvs.2014.07.100) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Transarterial embolization. a, A 6F sheath has been placed in the internal iliac artery, and a 5F selective catheter is used to image the endoleak. b, A microcatheter is guided over a microwire (coaxial system) toward the lumbar artery origin. c, Microcoils are used, and there is no residual endoleak. d, Six months later, the endoleak persists and the abdominal aortic aneurysm is expanding; more feeders are identified (arrow). e, The microcatheter is again used to reach the abdominal aortic aneurysm sac. f, Nidus and branches are coiled and endoleak resolves. Journal of Vascular Surgery 2014 60, 1386-1391DOI: (10.1016/j.jvs.2014.07.100) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Translumbar embolization. a, With the patient in the prone position, access has been obtained through the left paraspinal approach, and a 6F 30-cm sheath has been introduced into the abdominal aortic aneurysm sac. b, A sacogram is obtained that reveals the endoleak. c, A 5F catheter is used to guide embolization. d, The nidus is embolized with multiple coils. Journal of Vascular Surgery 2014 60, 1386-1391DOI: (10.1016/j.jvs.2014.07.100) Copyright © 2014 Society for Vascular Surgery Terms and Conditions