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Direct percutaneous embolization of aneurysm sac: a safe and effective procedure to treat post-EVAR type II endoleaks

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Abstract

Purpose

To report safety and effectiveness of type II endoleak embolization, with percutaneous direct aneurysm sac puncture.

Materials and methods

Fifty patients, 31 male (mean age 55 ± 5), with post-EVAR type-II endoleak underwent direct percutaneous sac puncture for embolization. Procedures were performed, under local anesthesia. Sac puncture was done using a 20G needle under rotational angiography guidance. A coaxial system (4 Fr catheter + 2.7 microcatheter) was used to navigate the sac. During the follow-up period, all patients underwent contrast-enhanced ultrasound (CEUS) at 6 and 12 months.

Results

Technical success, with complete exclusion of the aneurysm sac, was achieved in all cases. Time of procedure varied between 36 and 68 min (mean 51.36 min). Mean fluoroscopy time was 16.7 min. A posterior left access was used in 41 cases, posterior right access in 6 cases, and an anterior approach in 3. In 19 cases (38%), one or more feeding vessels were visualized and embolized. Sac embolization was done using Onyx plus micro-coils in 31 cases (62%) and Onyx alone in 19 cases (38%). Mean amount of Onyx was 6 ml. No complications, correlated with the direct percutaneous sac puncture, or to Onyx injection occurred. After 1-year follow-up, sac shrinkage occurred in 34 cases (68%), while in 16 patients (32%) sac size remained stable without evidence of sac perfusion.

Conclusion

Percutaneous direct sac embolization using Onyx in combination or not with microcoils represents a safe and valid technique to solve post-EVAR type II endoleaks.

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Author notes

  1. Fabrizio Fanelli and Alessandro Cannavale are co-first authors.

Authors and Affiliations

  1. Vascular and Interventional Radiology Department, “Careggi” University Hospital, Florence, Italy

    Fabrizio Fanelli, Michele Citone & Gian Marco Falcone

  2. Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 166 Viale del Policlinico, 00161, Rome, Italy

    Alessandro Cannavale

  3. Vascular Surgery Department, Ospedale San Giovanni Di Dio Di Firenze, Florence, Italy

    Emiliano Chisci & Stefano Michelagnoli

  4. Department of Emergency Radiology, “Careggi” University Hospital, Florence, Italy

    Vittorio Miele

Authors
  1. Fabrizio Fanelli
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  2. Alessandro Cannavale
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  3. Emiliano Chisci
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  4. Michele Citone
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  5. Gian Marco Falcone
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  6. Stefano Michelagnoli
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  7. Vittorio Miele
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Correspondence to Alessandro Cannavale.

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This is a prospective clinical study involving patients.

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Informed consent was collected from all patients included in this study.

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Fanelli, F., Cannavale, A., Chisci, E. et al. Direct percutaneous embolization of aneurysm sac: a safe and effective procedure to treat post-EVAR type II endoleaks. Radiol med 126, 258–263 (2021). https://doi.org/10.1007/s11547-020-01247-2

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  • DOI: https://doi.org/10.1007/s11547-020-01247-2

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