Prevention of Type II Endoleak Using Postoperative Coiling of the Abdominal Aortic Aneurysm Sac during Stent Graft Implantation

Česká verzia

Authors: P. Šedivý; K. El Samman; K. Bartík; T. Mach ^*; M. Šlais; P. Štádler; H. Přindišová
Authors place of work: Oddělení cévní chirurgie, NsP Na Homolce, Praha 5, primář: doc. MUDr. Petr Štádler, Ph. D. ; Oddělení radiodiagnostiky, NsP Na Homolce, Praha 5, primář: prof. MUDr. Josef Vymazal, DrSc. ^*
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 1, s. 18-23.
Category: Monothematic special - Original

Summary

Aim:
A prospective randomized study assessing the success rates of type II endoleak (EL) prevention, using postoperative coiling of the abdominal aortic aneurysm (AAA) sac during stent graft (SG) implantation.

Material and Methods:
From January 2008 to July 2009, 86 patients were operated for AAA using endovascular methods with bifurcation SG. The subjects were prospectively randomized into two subgroups. Group A subjects (42 subjects; 48.8%) had various numbers of coils introduced into the sac, close to the SG body. Group B (44 subjects; 51.2%) included patients without coils. Preoperative CT angiograhy (CT AG) was used to assess patency and the number of lumbal arteries (AL), a.mesenterica inferior (AMI), a. sacralis mediana (ASM) and aa. renales accessoriae (ARA), the AAA sac and the lumen size. At the end of the studied period, existence of type II EL and the AAA sac size was assessed using sonography and /or CT AG.

Results:
Prior to the procedure, there were only minor differencies in the number of source type II EL arteries (AL 3.8 vs. 3.5; AMI 0.78 vs. 0.55; ASM 0.26 vs. 0.3; ARA 0.095 vs. 0.05), preoperative AAA sac size (68.6 vs. 67.0 mm) and the lumen size (47.6 vs. 40.0 mm), the AAA sac size at the end of the studied period (63.9 vs. 62.1 mm) and its mean size change (-4.7 vs. -4.9 mm), between the Group A and B, respectively . Postoperatively, the type II EL was detected in 6 subjects in Group A (14.3%), and in 9 subjects in Group B (20.5%). At the study endpoint, the type II EL was identified in 4 subjects in Group A (9.5%), in 8 subjects in Group B (18.2%).

Conclusion:
Peroperative introduction of coils into the AAA sac is one of the options for type II EL prevention. It facilitates successful regression and disappearance of type II EL.

Key words:
endoleak – abdominal aortic aneurysm – coil – stent graft

Zdroje

1. Hinchliffe, R. J., Singh-Ranger, R., Davidson, I. R., Hopkinson, B. R. Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur. J. Vasc. Endovasc. Surg., 2001 Dec; 22 (6): 563–565.

2. White, R. A., Donayre, C., Walot, I., Stewart, M. Abdominal aortic aneurysm rupture following endoluminal graft deployment: report of a predictable event. J. Endovasc. Ther., 2000 Aug; 7(4): 257–262.

3. Schlösser, F. J., Gusberg, R. J., Dardik, A., Lin, P. H., Verhagen, H. J., Moll, F. L., Much, B. E. Aneurysm rupture after EVAR: can the ultimate failure be predicted? Eur. J. Vasc. Endovasc. Surg., 2009 Jan; 37(1): 15–22.

4. Steinmetz, E., Rubin, B. G, Sanchez, L. A., Choi, E. T., Geraghty, P. J., Baty, J., Thompson, R. W., Flye, M. W., Hovsepian, D. M., Picus, D., Sicard, G. A. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J. Vasc. Surg., 2004; 39(2): 306–313.

5. Waasdorp, E., van Herwaarden, J. A., van de Mortel, R. H., Moll, F. L., de Vries, J. P. Early computed tomographic angiography after endovascular aneurysm repair: worthwhile or worthless? Vascular., 2008 Sep-Oct; 16(5): 253–237.

6. Conrad, M. F., Adams, A. B., Guest, J. M., Peruchuri, V., Brewster, D. C., Lamuraglia, G. M., Cambria, R. P. Secondary intervention after endovascular surgery. Ann. Surg., 2009 Jul 31 (e-publikace před tiskem).

7. Barbiero, G., Baratto, A., Ferro, F., DallęAcqua, J., Fitta, C., Motto, D. Strategies of endoleak management following endoluminal treatment of abdominal aortic aneurysms in 95 patients: how, when and why. Radiol. Med., 2008; 113(7):1029–1042.

8. Axelrod, D. J., Lookstein, R. A., Guller, J., Nowakowski, F. S., Ellozy, S., Carrocio, A., Teodorescu, V., Marin, M. L., Mitty, H. A. Inferior mesenteric artery embolization before endovascular aneurysm repair: technique and initial results. J. Vasc. Interv. Radiol., 2004; 15(11): 1263–1267.

9. Du Toit, D. F., Saaiman, J. A., Labuschagne, B. C., Vorster, W., van Beek, F. J., Boden, B. H., Geldenhuys, K. M. EVAR: critical applied aortic morphology relevant to type-II endoleaks following device enhancement in patients with abdominal aortic aneurysms. Cardiovasc. J. S. Afr., 2004; 15(4): 170–177.

10. Zanchetta, M., Faresin, F., Pedon, L., Ronsivalle, S. Intraoperative intrasac thrombin injection to prevent type II endoleak after endovascular abdominal aortic aneurysm repair. J Endovasc Ther., 2007 Apr; 14(2): 176–183.

11. Bonvini, R., Alerci, M., Antonucci, F., Tutta, P., Wyttenbach, R., Bogen, M., Pelloni, A,. von Segesser, L., Gallino, A. Preoperative embolization of collateral side branches: a valid means to reduce type II endoleaks after endovascular AAA repair. J. Endovasc. Ther., 2003; 10(2): 227–232.

12. Nevala, T., Biancari, F., Manninen, H., Aho, P. S., Matsi, P., Mäkinen, K., Roth, W. D., Ylönen, K., Lepäntalo, M., Perälä, J. Type II Endoleak After Endovascular Repair of Abdominal Aortic Aneurysm: Effectiveness of Embolization. Cardiovasc. Intervent. Radiol., 2009 Aug 18 (e-publikace před tiskem).

13. Walker, S. R., Macierewicz, J., Hopkinson, B. R. Endovascular AAA repair: prevention of side branch endoleaks with thrombogenic sponge. J. Endovasc. Surg., 1999 Nov; 6(4): 350–353.

14. Sheehan, M. K., Hagino, R. T., Canby, E., Wholey, M. H., Postoak, D., Suri, R., Toursarkissian, B. Type 2 endoleaks after abdominal aortic aneurysm stent grafting with systematic mesenteric and lumbar coil embolization. Ann. Vasc. Surg., 2006 Jul; 20(4): 458–463.

15. Gould, D. A., McWilliams, R., Edwards, R. D., Martin, J., White, D., Joekes, E., Rowlands, P. C., Brennan, J., Gilling-Smith, G., Harris, P. L. Aortic side branch embolization before endovascular aneurysm repair: incidence of type II endoleak. J. Vasc. Interv. Radiol., 2001 Mar; 12(3): 337–341.

16. Hiramoto, J. S., Howell, B., Reilly, L. M., Chuter, T. A. Effect of systemic blood pressure on aneurysm size in the presence of a type II endoleak. Vascular., 2008 Nov-Dec; 16(6): 321–325.

17. Kasirajan, K., Matteson, B., Marek, J. M., Langsfeld, M. Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J. Vasc. Surg., 2003 Jul; 38(1): 61–66.

18. Muthu, C., Maani, J., Plank, L. D., Holden, A., Hill, A. Strategies to reduce the rate of type II endoleaks: routine intraoperative embolization of the inferior mesenteric artery and thrombin injection into the aneurysm sac. J. Endovasc. Ther., 2007 Oct; 14(5): 661–668.

19. Bush, R. L., Lin, P. H., Ronson, R. S., Conklin, B. S., Martin, L. G., Lumsden, A. B. Colonic necrosis subsequent to catheter-directed thrombin embolization of the inferior mesenteric artery: a complication in the management of a type II endoleak. J. Vasc. Surg., 2001 Dec; 34(6): 1119–1122.

20. Parry, D. J., Kessel, D. O., Robertson, I., Denton, L., Patel, J. V., Berridge, D. C. Type II endoleaks: predictable, preventable, and sometimes treatable? J. Vasc. Surg., 2002 Jul; 36 (1): 105–110.

21. Mehta, M., Darling, R. C. 3rd, Chang, B. B., Paty, P. S., Roddy, S. P., Kreiberg, P. B., Ozsvath, K. J., Shah, D. M. Does sac size matter? Findings based on surgical exploration of excluded abdominal aortic aneurysms. J. Endovasc. Ther., 2005 12(2): 183–188.