Transcaval embolization as an alternative technique for the treatment of type II endoleak after endovascular aortic aneurysm repair Salvatore T. Scali,

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Presentation transcript:

Transcaval embolization as an alternative technique for the treatment of type II endoleak after endovascular aortic aneurysm repair Salvatore T. Scali, MD, Adrian Vlada, MD, Catherine K. Chang, MD, Adam W. Beck, MD Journal of Vascular Surgery Volume 57, Issue 3, Pages 869-874 (March 2013) DOI: 10.1016/j.jvs.2012.09.021 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Lateral aortic projection with the ring pediatric transjugular intrahepatic portosystemic shunt (TIPS) catheter in place while a retrievable coil is delivered. The black arrow denotes the end of a Spectranetics Quick-Cross catheter (Spectranetics Corporation, Colorado Springs, Colo) within the aneurysm sac with a 0.035-inch coil arising from the catheter. The white arrows indicate coils placed at a previous intervention through a superior mesenteric artery to inferior mesenteric artery approach that failed to obliterate the endoleak. The inset is an ex vivo picture of the pediatric TIPS catheter with the guiding catheter and TIPS needle within the guiding sheath. B, Close approximation of the inferior vena cava to the abdominal aortic aneurysm sac and a pediatric TIPS catheter in place delivering coils to the abdominal aortic aneurysm sac. Journal of Vascular Surgery 2013 57, 869-874DOI: (10.1016/j.jvs.2012.09.021) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Axial computed tomographic scan before (top panels) and after (bottom panels) transcaval embolization of a type II endoleak. Note the close approximation of the inferior vena cava to the abdominal aortic aneurysm sac. Journal of Vascular Surgery 2013 57, 869-874DOI: (10.1016/j.jvs.2012.09.021) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Algorithm demonstrating our current treatment paradigm for type II endoleaks, with an emphasis on delivering coils directly to the excluded abdominal aortic aneurysm sac. CT, Computed tomography; EL, endoleak; IMA, inferior mesenteric artery; IVC, inferior vena cava; SMA, superior mesenteric artery. Journal of Vascular Surgery 2013 57, 869-874DOI: (10.1016/j.jvs.2012.09.021) Copyright © 2013 Society for Vascular Surgery Terms and Conditions