Karthikeshwar Kasirajan, MD, Brian Matteson, MD, John M

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Presentation transcript:

Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak Karthikeshwar Kasirajan, MD, Brian Matteson, MD, John M. Marek, MD, Mark Langsfeld, MD Journal of Vascular Surgery Volume 38, Issue 1, Pages 61-66 (July 2003) DOI: 10.1016/S0741-5214(02)75467-0

Fig 1 A, Technique of transfemoral cannulation of proximal internal iliac artery branch. Internal iliac access maintained with 7F Balkan sheath held in place with a Rosen wire in the distal internal iliac. Arrow, Tip of Balkan sheath at origin of internal iliac artery. B, 5F angled glide wire (arrow at tip) is passed alongside Rosen wire to cannulate iliolumbar artery. C, Tracker18 (3F; small arrow) is passed alongside Rosen wire through a 5F angled glide wire catheter (large arrow). Journal of Vascular Surgery 2003 38, 61-66DOI: (10.1016/S0741-5214(02)75467-0)

Fig 2 A, Tracker18 in a feeding vessel. Angiogram demonstrates type II leak with outflow branches. B, Complete aneurysm and feeding vessel (arrow) coiling to treat persistent type II endoleak. Journal of Vascular Surgery 2003 38, 61-66DOI: (10.1016/S0741-5214(02)75467-0)

Fig 3 A, Type II endoleak via numerous small, tortuous lumbar arteries. Access to sac was not possible, and collateral vessels persist despite proximal coiling. Arrow, Site of coil placement and persistent flow of contrast material into retiform collateral vessels. B, Lumbar vessels thrombosed with a combination of liquid embolic agent and coils Arrow, Site of coil. Note no flow beyond this level. Journal of Vascular Surgery 2003 38, 61-66DOI: (10.1016/S0741-5214(02)75467-0)

Fig 4 A, Aneurysm sac access via superior mesenteric artery and arc of Riolan. Arrows delineate course of Tracker18 catheter in meandering mesenteric artery. B, Coils in outflow lumbar arteries, aneurysm, and distal inferior mesenteric artery. Arc of Riolan is spared to preserve colonic perfusion. Journal of Vascular Surgery 2003 38, 61-66DOI: (10.1016/S0741-5214(02)75467-0)