Abstract
Objective: Translumbar embolization (TLE) of type II endoleaks has been described for the treatment of enlarging aneurysms following EVAR. This technique is reported to have a very high rate of technical success and durability. The purpose of this study is to review our experience with TLE in controlling type II endoleaks, in arresting the increase in aneurysm growth, and limiting the need for subsequent intervention. Methods: A retrospective case review was performed on 13 patients with CT and/or angiographically confirmed type II endoleaks who underwent TLE at two institutions. Patients were treated with combinations of stainless-steal coils, Onyx, Cyanoacrylate (NBCA), thrombin, and/or poly vinyl alcohol (PVA) beads. Success was defined as clear resolution of the type II endoleak and/or an aneurysm diameter that was either stable or decreasing. Failure of the technique was defined as any persistent leak, an enlarging aneurysm sac, or the need for secondary intervention. Results: Thirteen patients underwent TLE for type II endoleaks associated with aneurysm enlargement. In two patients who underwent translumbar puncture, no endoleak could be identified, and no treatment was performed. TLE was successful in only 5 (45.5%) of the remaining 11 patients. Six patients (54.5%) had unsuccessful TLE. Of the 6 treatment failures; 2 patients required repeat interventions, 2 required open surgical repair (1 for rupture), 1 suffered colonic ischemia requiring resection, and 1 patient has a persistent type II endoleak. Conclusions: Our experience contrasts with previously published studies in that less than half of the patients treated had successful resolution of their endoleak with TLE alone. Although TLE is a useful technique for the management of type II endoleaks, many patients will require subsequent procedures. Close surveillance of patients after TLE is imperative to identify the patients who will require additional intervention. The practice gap addressed is the difficulty in obtaining adequate results using TLE in treating endoleaks. A small number of previously published studies showed high success rates. By identifying a lower success rate for TLE, we hope to impress the importance of vigorous surveillance after the procedure.
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