Seyed Ameli-Renani, MBBS, FRCR, Vyzantios Pavlidis, MD, Robert A

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Presentation transcript:

Early and midterm outcomes after transcatheter embolization of type I endoleaks in 25 patients Seyed Ameli-Renani, MBBS, FRCR, Vyzantios Pavlidis, MD, Robert A. Morgan, MRCP, FRCR, EBIR Journal of Vascular Surgery Volume 65, Issue 2, Pages 346-355 (February 2017) DOI: 10.1016/j.jvs.2016.06.101 Copyright © 2016 Terms and Conditions

Fig 1 Proximal type I endoleak (ELIa) embolization. a, An axial computed tomography angiogram (CTA) performed nearly 5 years after endovascular aortic repair (EVAR) shows ELIa at the left lateral side of the endograft (arrow). b, A transcatheter aortogram performed by placing a flush catheter above the proximal endograft confirms the endoleak (arrow); note the adjacent renal arteries. c, An endoleakogram performed after endoleak catheterization using a reverse-shaped catheter depicts the endoleak and its wide neck more clearly. d, Single exposure obtained after embolization with coils and then Onyx (ev3 Endovascular, Inc, Plymouth, Minn). e, A postoperative aortic angiogram shows embolization is satisfactory, with preserved filling of both renal arteries and no residual endoleak. A follow-up duplex scan at 8 months after embolization showed no endoleak and a reduction of sac size from 100 to 92 mm (not shown). Journal of Vascular Surgery 2017 65, 346-355DOI: (10.1016/j.jvs.2016.06.101) Copyright © 2016 Terms and Conditions

Fig 2 Embolization of a distal type I endoleak (ELIb). a, A sagittal computed tomography angiogram (CTA) performed 2 days after endovascular aortic repair (EVAR) shows a distal ELIb (arrow). The endograft extends to the celiac axis origin and thus could not be extended. Transcatheter embolization with Onyx (ev3 Endovascular, Inc, Plymouth, Minn) was performed. b, An oblique aortic angiogram performed through a flush catheter placed at the distal end of the endograft confirms the ELIb (arrow). c, The endoleak was catheterized and an endoleakogram was performed through microcatheter advanced into endoleak cavity to better depict the size and morphology of the endoleak. d, Single exposure obtained after completion of Onyx embolization. e, A postoperative aortic angiogram shows the embolization appears satisfactory, with no residual endoleak. f, A sagittal CTA performed 68 days after embolization shows no residual endoleak and sac size reduction from 74 to 70 cm. Journal of Vascular Surgery 2017 65, 346-355DOI: (10.1016/j.jvs.2016.06.101) Copyright © 2016 Terms and Conditions

Fig 3 Kaplan-Meier curves demonstrate freedom from (left) endoleak recurrence and (right) sac size increase after endovascular embolization. Journal of Vascular Surgery 2017 65, 346-355DOI: (10.1016/j.jvs.2016.06.101) Copyright © 2016 Terms and Conditions

Fig 4 Kaplan-Meier curves demonstrate freedom from (left) endoleak recurrence and (right) sac size increase after embolization, subdivided into cases with the Nellix (Endologix, Santa Rosa, Calif) endograft compared with conventional endovascular aortic repair (EVAR). There was one endoleak recurrence within the Nellix cohort at 395 days after embolization but no sac size increase. Journal of Vascular Surgery 2017 65, 346-355DOI: (10.1016/j.jvs.2016.06.101) Copyright © 2016 Terms and Conditions

Fig 5 Large endoleak with unfavorable morphology for embolization. a and b, A computed tomography angiogram (CTA) 3 years after endovascular aortic repair (EVAR) shows distal migration of the endograft, a contained endoleak rupture, and a large type Ia endoleak (ELIa; arrow), ∼80 mL, with a wide neck measuring 4.1 cm. c, Embolization procedure: single exposure shows microcatheter tip (arrowhead) advanced into the base of the endoleak after catheterization with a reverse-shaped catheter. d, Endoleak cavity progressively filled with Onyx (ev3 Endovascular, Inc, Plymouth, Minn) under close monitoring. CTA images obtained 3 days after embolization in (e) axial and (f) sagittal views show filling of the endoleak cavity with Onyx and no endoleak visible; however, (g) axial and (h) sagittal CTA images at 101 days after embolization clearly show recurrent endoleak at the proximal end of the graft. h, Note the Onyx material appears to have migrated inferiorly within the aneurysm sac (arrow) on the sagittal image, and there is consequent patency of the endoleak neck on the axial image. Patient had multiple comorbidities, and a further embolization procedure was deemed not appropriate. Journal of Vascular Surgery 2017 65, 346-355DOI: (10.1016/j.jvs.2016.06.101) Copyright © 2016 Terms and Conditions