Double Coaxial Microcatheter Technique for Transarterial Aneurysm Sac Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Repair |
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| Affiliation: | 1. Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593;2. Department of Cardiovascular Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593;1. Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH 44106;2. Department of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH 44106;3. Department of Urology, University Hospitals Case Medical Center, Cleveland, OH 44106;4. Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106;5. Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106;6. The Centers for Dialysis Care, Shaker Heights, Ohio;1. Department of Radiology, University Hospitals Paris Nord Val de Seine Beaujon, 100 Boulevard du Général Leclerc, 92118 Clichy, France;2. Université Paris Diderot–Paris 7, Sorbonne Paris Cité, Paris, France;3. Institut National de la Santé et de la Recherche Médicale U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Paris, France;1. Department of Vascular & Interventional Radiology, American Medical Center, Nicosia, Cyprus;2. Department of Cardiothoracic Surgery, American Medical Center, Nicosia, Cyprus;3. Department of Cardiology, American Medical Center, Nicosia, Cyprus |
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| Abstract: | PurposeTo evaluate the feasibility and efficacy of transarterial sac embolization with a mixture of N-butyl cyanoacrylate and ethiodized oil (Lipiodol; Guerbet Japan, Tokyo, Japan) (NBCA-LPD) for type II endoleaks after endovascular aortic repair (EVAR) using a double coaxial microcatheter technique.Materials and MethodsA retrospective review was performed of 20 consecutive cases of type II endoleaks treated by transarterial embolization using the technique from August 2010 to June 2013. The treatment indication was persistent type II endoleak over 6 months after EVAR associated with aneurysm expansion ≥ 5 mm in maximum diameter. A 1.9-F nontapered microcatheter was advanced to the aneurysmal sac through a 2.7-F microcatheter, which was coaxially introduced through a catheter. The endpoint of the procedure was intrasaccular filling with NBCA-LPD and occlusion of the feeder of the type II endoleak. The technical success rate was defined as success in transarterial intrasaccular approach followed by embolization of the intrasaccular channel and inflow arteries. Clinical success was defined as aneurysmal sac shrinkage or stabilization (freedom from sac expansion > 5 mm in maximum diameter).ResultsTechnical success was achieved in 18 of 20 cases. During a mean follow-up period of 18.5 months, complete sac occlusion was observed in 13 cases (65%). Clinical success was achieved in 16 cases (80%). No serious complications were observed.ConclusionsThe transarterial intrasaccular approach with a double coaxial microcatheter technique can be successfully performed in most cases, and transarterial aneurysm sac embolization using NBCA-LPD has been proven to be feasible. |
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