Transcaval Access Provides a Safe and Effective Method in the Treatment of Type II Endoleaks

Abstract

We aimed to describe our technique and preliminary results of transcaval access for treatment of type II endoleaks after endovascular aneurysm repair. We performed a retrospective review of a prospective data registry collected from January 1, 2015, to March 1, 2016. Our standardized technique is described as follows. Under fluoroscopic guidance, a 19-gauge transjugular liver biopsy needle is passed by transfemoral venous access through the inferior vena cava into the aneurysm sac at the site of maximal aortocaval apposition. Confirmation of sac entrance is confirmed by anterior/posterior and lateral fluoroscopic and angiographic imaging. Over a stiff wire, a sheath and catheter are then introduced into the aneurysm sac. Transarterial, intra-aortic angiography facilitates localization of the endoleaks. The intrasac catheter and wire are used to catheterize the ostium of the vessel responsible for type II endoleak. Coil embolization of the catheterized vessel or of the vessel ostium is performed. Technical success was defined as resolution of the endoleak on repeated intra-arterial angiography. Additional outcome measures included resolution of the type II endoleak and aneurysm sac expansion on follow-up imaging. Computed tomography angiography was performed for all patients except those with stage 3 or higher chronic kidney disease. Abdominal aortic duplex ultrasound was used to determine the presence of endoleak in these patients. Four patients underwent transcaval embolization for an expanding aneurysm sac; 75% of the patients were male. The average age was 78.7 years. Average preintervention aneurysm sac size was 8.5 cm (6.7-10.6 cm). In two patients, previous transarterial/translumbar embolization attempts had failed. The technical success rate for transcaval embolization was 100%. The average fluoroscopy time was 34.6 minutes. The average amount of contrast material administered was 60 mL. The number of coils deployed averaged 8.75 (3-11). There were no immediate postoperative complications. Follow-up ranged from 1 to 12 months. All patients remained free of endoleaks with stable or decreasing aneurysm sac size. No patients developed any complications associated with the inferior vena cava or femoral veins. Transcaval access is a safe and effective alternative method for treating type II endoleaks. In addition, it can be considered a primary or secondary approach after failed intra-arterial or translumbar attempts.