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Unenhanced Cone Beam Computed Tomography and Fusion Imaging in Direct Percutaneous Sac Injection for Treatment of Type II Endoleak: Technical Note

CardioVascular and Interventional Radiology volume 39, pages 447–452 (2016)Cite this article

An Erratum to this article was published on 09 November 2015

Abstract

Aim

To evaluate safety, feasibility, technical success, and clinical success of direct percutaneous sac injection (DPSI) for the treatment of type II endoleaks (T2EL) using anatomical landmarks on cone beam computed tomography (CBCT) and fusion imaging (FI).

Materials and Methods

Eight patients with T2EL were treated with DPSI using CBCT as imaging guidance. Anatomical landmarks on unenhanced CBCT were used for referencing T2EL location in the first five patients, while FI between unenhanced CBCT and pre-procedural computed tomography angiography (CTA) was used in the remaining three patients. Embolization was performed with thrombin, glue, and ethylene–vinyl alcohol copolymer. Technical and clinical success, iodinated contrast utilization, procedural time, fluoroscopy time, and mean radiation dose were registered.

Results

DPSI was technically successful in all patients: the needle was correctly positioned at the first attempt in six patients, while in two of the first five patients the needle was repositioned once. Neither minor nor major complications were registered. Average procedural time was 45 min and the average administered iodinated contrast was 13 ml. Mean radiation dose of the procedure was 60.43 Gy cm2 and mean fluoroscopy time was 18 min. Clinical success was achieved in all patients (mean follow-up of 36 months): no sign of T2EL was reported in seven patients until last CT follow-up, while it persisted in one patient with stability of sac diameter.

Conclusions

DPSI using unenhanced CBCT and FI is feasible and provides the interventional radiologist with an accurate and safe alternative to endovascular treatment with limited iodinated contrast utilization.

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References

  1. Parent FN, Meier GH, Godziachvili V, et al. The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg. 2002;35(3):474–81.

    Article  PubMed  Google Scholar 

  2. Gelfand DV, White GH, Wilson SE. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg. 2006;20:69–74.

    Article  PubMed  Google Scholar 

  3. Ogawa Y, Hamaguchi S, Nishimaki H, Kon Y, Chiba K, Sakurai Y, et al. Embolization by direct puncture with a transpedicular approach using an isocenter puncture (ISOP) method in a patient with a Type II endoleak after endovascular aortic repair (EVAR). Cardiovasc Interv Radiol. 2015;38:731–5.

    Article  Google Scholar 

  4. Binkert Christoph A, Alencar Herlen, Singh Jai, Baum Richard A. Translumbar type II endoleak repair using angiographic CT. J Vasc Interv Radiol. 2006;17(8):1349–53.

    Article  PubMed  Google Scholar 

  5. Golzarian J, Mess EB, Sun S. Endoleak: treatments options. Tech Vasc Interv Radiol. 2005;8:41–9.

    Article  PubMed  Google Scholar 

  6. Karaman K, Dokdok AM, Karedeniz O. CT- and fluoroscopy-guided percutaneous transabdominal embolization of Type II endoleak. Eurasian J Med. 2013;45:132–4.

    PubMed Central  Article  PubMed  Google Scholar 

  7. Aziz A, Menias CO, Sanchez LA, Picus D, Saad N, Rubin BG, et al. Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion. J Vasc Surg. 2012;55:1263–7.

    Article  PubMed  Google Scholar 

  8. Gorlitzer M, Mertikian G, Trnka H, Froeschl A, Meinhart J, Weiss G, et al. Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm. Interact CardioVasc Thorac Surg. 2008;7(5):781–4.

    Article  PubMed  Google Scholar 

  9. Boks SS, Andhyiswara T, de Smet AA, Vroegindeweij D. Ultrasound-guided percutaneous transabdominal treatment of a type 2 endoleak. Cardiovasc Interv Radiol. 2005;28:526–9.

    Article  Google Scholar 

  10. Uthoff H, Katzen BT, Gandhi R, Pena CS, Benenati JF, Geisbusch P. Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg. 2012;56:965–72.

    Article  PubMed  Google Scholar 

  11. Park YS, Do YS, Park HS, Park KB, Kim DI. Experience of direct percutaneous sac injection in type II endoleak using cone beam computed tomography. Ann Surg Treat Res. 2015;88(4):232–5.

    PubMed Central  Article  PubMed  Google Scholar 

  12. van Bindsbergen L, Braak JS, van Strijen MJL, de Vries JPPM. Type II endoleak embolization after endovascular abdominal aortic aneurysm repair with use of real-time three-dimensional fluoroscopic needle guidance. J Vasc Interv Radiol. 2010;21(9):1443–7.

    Article  PubMed  Google Scholar 

  13. Chaikof EL, Blankensteijn JD, Harris PL, White GH, Zarins CK, Bernhard VM, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2002;35:1048–60.

    Article  PubMed  Google Scholar 

  14. Rand T, Uberoi R, Cil B, Munneke G, Tsetis D. Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Interv Radiol. 2013;36:35–45.

    Article  CAS  Google Scholar 

  15. Hessel SJ, Adams DF, Abrams HL. Complications of angiography. Radiology. 1981;138:273–81.

    Article  CAS  PubMed  Google Scholar 

  16. Carrafiello G, Mangini M, De Bernardi I, et al. Microwave ablation therapy for treating primary and secondary lung tumours: technical note. Radiol Med. 2010;115(6):962–74.

    Article  CAS  PubMed  Google Scholar 

  17. Ierardi AM, Petrillo M, Xhepa G, Laganà D, Piacentino F, Floridi C, et al. Cone beam computed tomography images fusion in predicting lung ablation volumes: a feasibility study. Acta Radiol. 2015;. doi:10.1177/0284185115574874.

    PubMed  Google Scholar 

  18. Busser WM, Braak SJ, Futtener JJ, van Strijen MJ, Hoogeven YL, de Lange F, et al. Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance. Br J Radiol. 2013;86(1030):20130310.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  19. Mohlenbruch M, Nelles M, Thomas D, et al. Cone-beam computed tomography-guided percutaneous radiologic gastrostomy. Cardiovasc Interv Radiol. 2010;33(2):315–20.

    Article  Google Scholar 

  20. Floridi C, Radaelli A, Abi-Jaoudeh N, Grass M, De Lin M, Chiaradia M, et al. C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications. Radiol Med. 2014;119(7):521–32.

    PubMed Central  Article  PubMed  Google Scholar 

  21. Tacher V, Radaelli A, Lin M, Geschwind JF. How I do it: Cone-beam CT during transarterial chemoembolization for liver cancer. Radiology. 2015;274(2):320–34.

    PubMed Central  Article  PubMed  Google Scholar 

  22. Angle JF. Cone-beam CT: vascular applications. Tech Vasc Interv Radiol. 2013;16(3):144–9.

    Article  PubMed  Google Scholar 

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Affiliations

  1. Interventional Radiology, Department of Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy

    Gianpaolo Carrafiello, Anna Maria Ierardi, Giuseppe De Marchi, Chiara Floridi & Fontana Federico

  2. Philips Healthcare, Best, The Netherlands

    Alessandro Radaelli

  3. Vascular Surgery Department, University of Insubria, Viale Borri, 57, 21100, Varese, VA, Italy

    Gabriele Piffaretti

Authors
  1. Gianpaolo Carrafiello
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  2. Anna Maria Ierardi
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  3. Alessandro Radaelli
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  4. Giuseppe De Marchi
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  5. Chiara Floridi
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  6. Gabriele Piffaretti
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  7. Fontana Federico
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Correspondence to Gianpaolo Carrafiello.

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Alessandro Radaelli declares to have conflict of interest; the remaining authors declare to have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Carrafiello, G., Ierardi, A.M., Radaelli, A. et al. Unenhanced Cone Beam Computed Tomography and Fusion Imaging in Direct Percutaneous Sac Injection for Treatment of Type II Endoleak: Technical Note. Cardiovasc Intervent Radiol 39, 447–452 (2016). https://doi.org/10.1007/s00270-015-1217-x

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  • DOI: https://doi.org/10.1007/s00270-015-1217-x

Keywords

  • Imaging
  • Clinical practice
  • Arterial intervention