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Operative Management of Type II Endoleaks After Aortic Endovascular Repair

  • Anna Maria Ierardi
  • Filippo Pesapane
  • Francesca Patella
  • Enrico Maria Fumarola
  • Salvatore Alessio Angileri
  • Mario Petrillo
  • Matteo Crippa
  • Gianpaolo CarrafielloEmail author
Chapter

Abstract

Endovascular aneurysm repair (EVAR) is associated with decreased periprocedural mortality, complications, and length of hospital stay compared to open repair.

Endoleaks can occur in 20–25% of patients after EVAR, with type II endoleaks being the most common.

They commonly occur from retrograde collateral blood flow into the aneurysm sac, typically from a lumbar artery or the inferior mesenteric artery (IMA).

Type II endoleaks are only treated if there is evidence of aneurysm growth (generally >5 mm). There are multiple approaches to the management of these endoleaks, including transarterial, translumbar, transcaval, and surgical approaches.

This chapter will look at the endovascular treatments, analyzing techniques, results, and modern tools available.

Notes

Compliance with Ethical Standards

Conflict of interest: The authors declare that they have no conflict of interest.

References

  1. 1.
    Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002;35(5):1029–35.PubMedCrossRefGoogle Scholar
  2. 2.
    Solis MM, Ayerdi J, Babcock GA, et al. Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization. J Vasc Surg. 2002;36(3):485–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Bryce Y, Rogoff P, Romanelli D, Reichle R. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications. Radiographics. 2015;35(2):593–615.PubMedCrossRefGoogle Scholar
  4. 4.
    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 Intervent Radiol. 2013;36(1):35–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Ierardi AM, Micieli C, Angileri SA, et al. Ethylene-vinyl alcohol copolymer as embolic agent for treatment of type II endoleak: our experience. Radiol Med. 2017;122(2):154–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Gelfand DV, White GH, Wilson SE. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg. 2006;20(1):69–74.PubMedCrossRefGoogle Scholar
  7. 7.
    Harris PL, Dimitri S. Predicting failure of endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 1999;17(1):1–2.PubMedCrossRefGoogle Scholar
  8. 8.
    Baum RA, Carpenter JP, Golden MA, et al. Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques. J Vasc Surg. 2002;35(1):23–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011;41(Suppl 1):S1–S58.PubMedCrossRefGoogle Scholar
  10. 10.
    EVAR Trial Participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365(9478):2187–92.CrossRefGoogle Scholar
  11. 11.
    Wisselink W, Cuesta MA, Berends FJ, van den Berg FG, Rauwerda JA. Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair. J Vasc Surg. 2000;31(6):1240–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Avgerinos ED, Chaer RA, Makaroun MS. Type II endoleaks. J Vasc Surg. 2014;60(5):1386–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Kasirajan K, Matteson B, Marek JM, Langsfeld M. Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J Vasc Surg. 2003;38(1):61–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Nevala T, Biancari F, Manninen H, et al. Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Intervent Radiol. 2010;33(2):278–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Ierardi AM, Pesapane F, Rivolta N, et al. Type 2 endoleaks in endovascular aortic repair: cone beam CT and automatic vessel detection to guide the embolization. Acta Radiol. 2018;59(6):681–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Patil VV, Fischman AM, Patel RS, et al. GI hemorrhage arising from splenic artery: intraprocedure cone-beam CT as problem-solving tool to aide in safe catheterization of offending vessel. Clin Imaging. 2015;39(5):928–30.PubMedCrossRefGoogle Scholar
  17. 17.
    Miyayama S, Yamashiro M, Okuda M, et al. Usefulness of cone-beam computed tomography during ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinomas that cannot be demonstrated on angiography. Cardiovasc Intervent Radiol. 2009;32(2):255–64.PubMedCrossRefGoogle Scholar
  18. 18.
    Ronot M, Abdel-Rehim M, Hakime A, et al. Cone-beam CT angiography for determination of tumor-feeding vessels during chemoembolization of liver Tumors: comparison of conventional and dedicated-software analysis. J Vasc Interv Radiol. 2016;27(1):32–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Carrafiello G, Ierardi AM, Duka E, et al. Usefulness of cone-beam computed tomography and automatic vessel detection software in emergency transarterial embolization. Cardiovasc Intervent Radiol. 2016;39(4):530–7.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Stavropoulos SW, Carpenter JP, Fairman RM, Golden MA, Baum RA. Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol. 2003;14(9 Pt 1):1191–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Ellis PK, Kennedy PT, Collins AJ, Blair PH. The use of direct thrombin injection to treat a type II endoleak following endovascular repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol. 2003;26(5):482–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Baum RA, Carpenter JP, Cope C, et al. Aneurysm sac pressure measurements after endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2001;33(1):32–41.PubMedCrossRefGoogle Scholar
  24. 24.
    Mansueto G, Cenzi D, Scuro A, et al. Treatment of type II endoleak with a transcatheter transcaval approach: results at 1-year follow-up. J Vasc Surg. 2007;45(6):1120–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Yang RY, Tan KT, Beecroft JR, Rajan DK, Jaskolka JD. Direct sac puncture versus transarterial embolization of type II endoleaks: an evaluation and comparison of outcomes. Vascular. 2017;25(3):227–33.PubMedCrossRefGoogle Scholar
  26. 26.
    Chung R, Morgan RA. Type 2 endoleaks post-EVAR: current evidence for rupture risk, intervention and outcomes of treatment. Cardiovasc Intervent Radiol. 2015;38(3):507–22.PubMedCrossRefGoogle Scholar
  27. 27.
    Baum RA, Stavropoulos SW, Fairman RM, Carpenter JP. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2003;14(9 Pt 1):1111–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Stavropoulos SW, Park J, Fairman R, Carpenter J. Type 2 endoleak embolization comparison: translumbar embolization versus modified transarterial embolization. J Vasc Interv Radiol. 2009;20(10):1299–302.PubMedCrossRefGoogle Scholar
  29. 29.
    Kuziez MS, Sanchez LA, Zayed MA. Abdominal aortic aneurysm type II endoleaks. J Cardiovasc Dis Diagn. 2016;4(5):255.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Golzarian J, Maes EB, Sun S. Endoleak: treatment options. Tech Vasc Interv Radiol. 2005;8(1):41–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Muller-Wille R, Wohlgemuth WA, Heiss P, et al. Transarterial embolization of type II endoleaks after EVAR: the role of ethylene vinyl alcohol copolymer (Onyx). Cardiovasc Intervent Radiol. 2013;36(5):1288–95.PubMedCrossRefGoogle Scholar
  32. 32.
    Khaja MS, Park AW, Swee W, et al. Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Intervent Radiol. 2014;37(3):613–22.PubMedCrossRefGoogle Scholar
  33. 33.
    Sidloff DA, Stather PW, Choke E, Bown MJ, Sayers RD. Type II endoleak after endovascular aneurysm repair. Br J Surg. 2013;100(10):1262–70.PubMedCrossRefGoogle Scholar
  34. 34.
    Angle JF. Cone-beam CT: vascular applications. Tech Vasc Interv Radiol. 2013;16(3):144–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Binkert CA, Alencar H, Singh J, Baum RA. Translumbar type II endoleak repair using angiographic CT. J Vasc Interv Radiol. 2006;17(8):1349–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Choi SY, Won JY, Lee DY, et al. Percutaneous transabdominal approach for the treatment of endoleaks after endovascular repair of infrarenal abdominal aortic aneurysm. Korean J Radiol. 2010;11(1):107–14.PubMedCrossRefGoogle Scholar
  37. 37.
    Rial R, Serrano Fj F, Vega M, et al. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: translumbar puncture and injection of thrombin into the aneurysm sac. Eur J Vasc Endovasc Surg. 2004;27(3):333–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Molyneux AJ, Coley SC. Embolization of spinal cord arteriovenous malformations with an ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx liquid embolic system). Report of two cases. J Neurosurg. 2000;93(2 Suppl):304–8.PubMedGoogle Scholar
  39. 39.
    Scali ST, Vlada A, Chang CK, Beck AW. Transcaval embolization as an alternative technique for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg. 2013;57(3):869–74.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anna Maria Ierardi
    • 1
  • Filippo Pesapane
    • 2
  • Francesca Patella
    • 2
  • Enrico Maria Fumarola
    • 2
  • Salvatore Alessio Angileri
    • 1
  • Mario Petrillo
    • 1
  • Matteo Crippa
    • 3
  • Gianpaolo Carrafiello
    • 1
    Email author
  1. 1.Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo HospitalUniversity of MilanMilanItaly
  2. 2.Postgraduation School in RadiodiagnosticsUniversità degli Studi di MilanoMilanItaly
  3. 3.Surgery Department, San Paolo HospitalUniversity of MilanMilanItaly

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