Treatment of type II endoleak with a transcatheter transcaval approach: Results at 1-year follow-up
Received 27 October 2006; accepted 25 January 2007.
Purpose
This study assessed the feasibility and mid-term outcomes in the treatment of type II endoleak using transcatheter transcaval embolization (TTE).
Methods
During an 8-month period, 12 patients underwent TTE. After direct transcaval puncture of the aneurysm sac, embolization was performed by injecting thrombin and placing coils. Systemic and intrasac pressures were recorded throughout the entire procedure. Computed tomography (CT) scans were performed at 24 hours, 30 days, 6 months, and 1 year after TTE to evaluate endoleaks and changes in sac diameter. Technical success was defined as the feasibility of the procedure; clinical success was defined as no evidence of leaks during the follow-up evaluation.
Results
TTE was feasible in 11 of 12 patients (technical success 92%). The mean systemic pressure was 117 mm Hg. The mean intrasac pressure before embolization was 75 mm Hg (range, 39 to 125 mm Hg), 16.5 mm Hg (range, 7 to 40 mm Hg) in 10 patients after embolization, and it increased in one patient. CT scans at 24 hours showed stable contrast medium inside the sac in 10 patients. Only minor complications were observed during follow-up. At the 1-year follow-up, no recurrence of leaks was noted, and sac diameter was reduced in 10 of 11 patients. As a result, TTE clinical success was obtained in 10 (83%) of 12 patients.
Conclusion
TTE appears to be a feasible technique for the complete exclusion of type II endoleaks. Technical and clinical successes are comparable with other treatment strategies, and TTE should be considered an alternative to direct translumbar puncture of the aneurysm sac.
aDepartment of Morphological and Biomedical Sciences—Radiology Institute, University of Verona, Verona, Italy
bDepartment of Vascular Surgery, University of Verona, Verona, Italy
cDepartment of Anesthesiology and Surgery—Intensive Care Unit, University of Verona, Verona, Italy
dDepartment of Surgery, New York Presbyterian, and the University Hospitals of Columbia and Cornell, New York, NY.
Reprint requests: Giancarlo Mansueto, Department of Morphological and Biomedical Sciences–Institute of Radiology, University Hospital “GB Rossi,” Piazza LA Scuro 10, 37134 Verona, Italy.
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