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Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

  • Vascular-Interventional
  • Published:
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Abstract

Objectives

To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR.

Methods

A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed.

Results

Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac.

Conclusions

Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible.

Key Points

• Endoleaks after thoracic endovascular aortic repair are common in 15-30 %.

• Most endoleaks can be treated by endovascular means.

• Direct percutaneous endoleak repair is described as a bail-out option.

• Direct percutaneous aortic arch coil embolisation of type 1a endoleak is possible.

• Antibiotic prophylaxis should be administered case by case, considering individual risk factors.

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Acknowledgments

The scientific guarantor of this publication is Christopher Bangard. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. No complex statistical methods were necessary for this article. Institutional Review Board approval was not required because retrospective data are presented. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University Hospital, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    Christopher Bangard, Mareike Franke, David Maintz & De-Hua Chang

  2. Department of Internal Medicine III, University Hospital, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    Roman Pfister

  3. Department of Cardiothoracic Surgery, University Hospital, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    Antje-Christin Deppe

  4. Department of Vascular Surgery, University Hospital, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    Vladimir Matoussevitch

Authors
  1. Christopher Bangard
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  2. Mareike Franke
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  3. Roman Pfister
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  4. Antje-Christin Deppe
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  5. Vladimir Matoussevitch
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  6. David Maintz
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  7. De-Hua Chang
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Corresponding author

Correspondence to Christopher Bangard.

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Bangard, C., Franke, M., Pfister, R. et al. Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts. Eur Radiol 24, 1430–1434 (2014). https://doi.org/10.1007/s00330-014-3143-8

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  • DOI: https://doi.org/10.1007/s00330-014-3143-8

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