Treatment options for endoleaks: stents, embolizations and conversions

Transcription

1 Treatment options for endoleaks: stents, embolizations and conversions Poster No.: C-0861 Congress: ECR 2012 Type: Authors: Keywords: DOI: Scientific Exhibit G. Lombardi; napoli/it Arteries / Aorta, Abdomen, Cardiovascular system, Catheter arteriography, Embolisation, Stents, Surgery, Aneurysms /ecr2012/C-0861 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Purpose The effectiveness of endovascular treatment of abdominal aortic aneurysm (AAA) may be limited by persistent perfusion of the aneurysm sac (endoleak). Endoleak that results in persistent systemic pressurization of the aneurysm or in continued AAA expansion is believed to require treatment to prevent rupture. The purpose of this study was to describe our experience of the techniques used to treat endoleak. Methods and Materials Between January 2000 and December 2008, 414 patients (382 men and 32 women) underwent endovascular repair of an infrarenal abdominal aortic aneurysm with an endoluminal stent graft. During the postprocedural follow-up period (4.5 ± 1.5 years). 34 endoleaks that required treatment. These involved 21 times the graft attachment site (type I - 10 Ia and 11 Ib), 1 time the graft junction site (type III) and 12 times originated from collateral side-branch vessels (type II) and were associated with an increase in aneurysm size. Endoleak type was confirmed at angiography in all cases. The techniques used for endoleak treatment were deployment of an endovascular extension graft or cuff (62%), coil embolization (35%), and conversion to conventional open repair (3%). After repair of the endoleak, all patients were enrolled in a standard follow-up protocol that included office visits within 1 month of treatment, at 6 and 12 months postoperatively, and annually thereafter. During the visit a detailed history was obtained and physical examination was performed. Plain radiographs of the abdomen and a contrast-enhanced helical computed tomography scan were also obtained at these follow-up visits. Images for this section: Page 2 of 9

3 Fig. 1: Angiografic - CT of type Ib Endoleak Page 3 of 9

4 Results Endovascular extension grafts or cuffs were used to treat 10 attachment site endoleaks and 11 graft junction endoleaks, with overall technical success rate of 95%. Embolic coils were used to treat 12 type II endoleaks, with overall technical success rate of 90%. Conversion to open surgery was performed in 2 patients with attachment site endoleaks, and was successful in all cases. After endoleak treatment, aneurysm size decreased (>5 mm) in 71% of patients, stabilized in 25% of patients, and increased (>5 mm) in 4% of patients. Images for this section: Fig. 2: Digital subtraction angiogram of distal attachment site endoleak treatment (type Ib). First Image, on frontal projection, extensive distal attachment site endoleak is seen originating between right and left aortic endoprosthesis branches. Second Image, On lateral projection, extensive distal attachment site endoleak is seen. Third Image, Completion angiogram confirms elimination of perfusion of the aneurysm with deployment of the extension graft. Page 4 of 9

5 Fig. 3: Digital subtraction angiogram of collateral branch endoleak treatment. Flush aortogram demonstrates that the type II endoleak originates from collateral communication between superior and inferior mesenteric arteries (Riolono artery). Page 5 of 9

6 Fig. 4: Digital subtraction angiogram of collateral branch endoleak treatment. Selective injection of the Riolono artery demonstrates cessation of aneurysm perfusion, after deployment of embolic coils and glue at site of origin of the artery from the aneurysm sac. Page 6 of 9

7 Fig. 5: Digital subtraction angiogram of collateral branch endoleak treatment. After deployment, coils and glue are visualized in side of aneurysm sac. Page 7 of 9

8 Fig. 6: Digital subtraction angiogram of junction attachment site endoleak treatment (type III). First Image, on lateral projection, extensive junction attachment site endoleak is seen. Second Image, On lateral projection, disjunction site between aortic and iliac endoprosthesis branches. Third Image, Completion angiogram confirms elimination of perfusion of the aneurysm with deployment of the extension graft. Page 8 of 9

9 Conclusion In repairing endoleaks, endovascular cuff extension, coil embolization, and conversion to conventional surgery each may be used effectively. Selection of the treatment method used for correction is determined by the anatomic characteristics of the endoleak and overall patient health. Deployment of an extension cuff was successful when complete closure of the endoleak was achieved. Embolic coils were effective for retrograde endoleaks, and they provided stabilization of AAA size in selected patients with attachment site endoleaks in limited follow-up. Conversion to open repair was uniformly successful in treating endoleaks, but was used only in patients without extensive comorbid conditions. Careful continued follow-up will be necessary to determine the long-term effectiveness of each of these techniques. References 1. Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. Faries PL, Cadot H, Agarwal G, Kent KC, Hollier LH, Marin ML. J Vasc Surg Jun;37(6): Diagnosis and management of type 2 endoleaks after endovascular aneurysm repair. Baum RA, Carpenter JP, Stavropoulous SW, Fairman RM. Tech Vasc Interv Radiol Dec;4(4): Endoleak after endovascular repair of abdominal aortic aneurysm. Chuter TA, Faruqi RM, Sawhney R, Reilly LM, Kerlan RB, Canto CJ, Lukaszewicz GC, Laberge JM, Wilson MW, Gordon RL, Wall SD, Rapp J, Messina LM. J Vasc Surg Jul;34(1): Personal Information Page 9 of 9