Multicenter Experience in Translumbar Type II Endoleak Treatment in the Hybrid Room With Needle Trajectory Planning and Fusion Guidance

Abstract

The objective of this study was to evaluate the efficacy of treating type II endoleaks (T2Ls) after aortic endovascular repair with image guidance translumbar puncture using intraoperative cone beam computed tomography with preprocedure computed tomography angiography fusion in hybrid operating rooms. There were 26 consecutive T2L patients in three different institutions treated between March 2015 and September 2017 using direct translumbar puncture of the abdominal aortic aneurysm (AAA) sac after previous endovascular aortic repair. All patients were treated at a single setting using a needle trajectory planning and guidance software (Needle ASSIST; GE Healthcare, Chicago, Ill). All patients (n = 26; 19 men, 7 women; age range, 59-95 years; mean body mass index, 27.44 ± 3.06 kg/m2) underwent treatment for AAA sac expansion or symptoms. Four patients had failed to respond to previous catheter-directed T2L treatment. Time to initial endoleak diagnosis ranged from 2 to 1914 days (average, 404 days). Aneurysm size after initial repair was 60.27 ± 7.5 mm; sac size had increased 10.12 ± 6.5 mm at the time of treatment. Onyx (ev3, Covidien, Plymouth, Minn) or glue (n-butyl cyanoacrylate) and coil embolization were used in 20 of 26 cases; 6 patients were treated with coiling alone. Total procedure time was 75.9 ± 40.7 minutes, contrast material volume was 19.9 ± 29 mL, fluoroscopy time was 13.74 ± 12.2 minutes, and radiation dose was 121.16 ± 167.7 mGy. After embolization, the mean sac diameter decreased by 4.3 mm to 64.6 ± 9.3 mm. The average follow-up period was 214 days. In 18 patients, the sac reduced in size from 0.2 to 47.62 mm/100 days; in 3 patients, there was continued AAA expansion (0.6 to 4.31 mm/100 days); there was no change in the sac size in 4 patients after the procedure. Once treated, the recurrence rate of T2L was low (Fig). The patients with sac growth tended to be associated with higher body mass index and baseline estimated glomerular filtration rate levels (P = .09). This initial multicenter evaluation of the effectiveness of fusion image-guided translumbar obliteration of T2L demonstrated that the technique was effective at all three study centers and showed excellent midterm efficacy to reduce AAA sac size. This may become a more effective and efficient method of treating T2L after endovascular aortic repair going forward.