Research Information System
72nd Congress of the European Society of CardioVascular and Endovascular Surgery, İstanbul, Turkey, 25 - 28 May 2024, pp.143-144, (Summary Text)
BACKGROUND: High-risk type 1a, 1b, III endoleaks requiring urgent intervention are one of the most common causes of secondary interventions; they should be repaired when detected.
CASE PRESENTATION: A 71-year-old polymorbid patient who underwent EVAR for infrarenal AAA six years ago presented to the emergency department. CTA showed 9 mm distal migration of the EVAR stent graft (SG) and contrast leakage consistent with a type 1a endoleak (EL1a).
In the first attempt, a proximal extending cuff SG was impelled proximally from the right CFA. In the control imaging, it was observed the leak persisted and apposition was performed with Reliant balloon. Tissel Lyo injection and coil were applied to the localisation with active turbulent flow by USG-guided puncture with transabdominal percutaneous approach to the sac. Control imaging showed persistence of leakage; the procedure was terminated because of the risk of contrast-induced AKI.
3 weeks later, RDUSG showed persistence of EL1a. It was decided to perform balloon apposition procedure to the proximal SG and transabdominal direct puncture to the aneurysm sac with coil + liquid embolising agent. In the second session, a Reliant balloon was propelled to the proximal aneurysm with access from the left CFA. Transabdominal puncture was performed in the aneurysm sac where active turbulent flow was observed on RDUSG. The EL1a origin point was entered in the neck of the aneurysm with a microcatheter through the acoustic triaxial set. A frame was created with multiple coils. The flow was briefly interrupted with a reliant balloon. Under fluoroscopy, coils and dens glue-lipiodol liquid embolising mixture were administered via microcatheter. No EL1a was observed in control imaging. Thrombosis of the aneurysm sac was confirmed.
CONCLUSIONS: In polymorbid patients with persistent EL1a, embolisation of the aneurysm sac with coils and glue through transabdominal direct puncture can be safely performed.
Keywords: Endoleak; Sac embolization; Transabdominal approach; Glue embolization; Abdominal aortic aneursym