Endovascular management of endotension by graft reinforcement followed by direct sac embolization

Purpose: To assess the efficacy of graft reinforcement followed by percutaneous direct sac embolization (PDSE) for the treatment of endotension after endovascular abdominal aortic aneurysm repair (EVAR).

Materials and methods: A total of 290 patients underwent elective EVAR. All patients regularly underwent scheduled surveillance with contrast-enhanced computed tomography (CT). Two hundred thirty-five patients were followed for ≥24?months after EVAR. Aneurysmal sac expansion of ≥10?mm was observed in 20 patients. The patients with sac expansion of ≥10?mm with no evidence of endoleak were treated with graft reinforcement. Graft reinforcement consisted of graft extension and graft relining. The patients with sac expansion at 6?months after graft reinforcement received PDSE using metallic coils and n-butyl cyanoacrylate–Lipiodol mixture. The aneurysm diameter was measured by CT performed 6?months and every year after the final intervention.

Results: Seven patients (7 men, 0 women; mean age, 69.1?±?4.2?years, Zenith^®:5/Excluder^®:1/Powerlink^®:1) underwent graft reinforcement. Two patients underwent graft reinforcement alone, and five patients underwent PDSE after graft reinforcement. Mean follow-up time after the final intervention was 21.1?months. The sac diameter stabilized after the final intervention in all patients.

Conclusion: Graft reinforcement followed by complementary PDSE could be a useful treatment strategy for endotension.