A Novel Treatment Approach to a Type II Endoleak at Endograft Implantation Using Components of an Endosensor Monitoring Device

Abstract

Purpose: There continues to be debate regarding optimal management of type II endoleaks following endovascular abdominal aortic aneurysm repair. Case Report: We present an intraoperative treatment approach to type II endoleaks using components of the EndoSure Intrasac Pressure Monitor System. Our technique can easily be reproduced with commercially available guidewires and catheters. We also present a literature review that identifies type II endoleak characteristics associated with a high rate of persistence (high-risk endoleaks) and could benefit from early treatment. Conclusions: If a high-risk type II endoleak is identified intraoperatively, those patients may benefit from our model of an early intervention strategy. Early definitive treatment of the endoleaks could result in lower morbidity and reintervention rates.

Keywords

type II endoleak endovascular repair abdominal aneurysm endosensor device

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References

Alimi YS , Chakfe N. , Rivoal E. , et al. Rupture of an abdominal aortic aneurysm after endovascular graft placement and aneurysm size reduction. J Vasc Surg. 1998;28(1):178-183.

Veith FJ , Baum RA , Ohki T. , et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002;35(5):1029-1035.

Arko FR , Filis KA , Siedel SA , et al. Intrasac flow velocities predict sealing of type II endoleaks after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003;37(1):8-15.

Velazquez OC , Baum RA , Carpenter JP , et al. Relationship between preoperative patency of the inferior mesenteric artery and subsequent occurrence of type II endoleak in patients undergoing endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000;32(4):777-788.

Timaran CH , Ohki T. , Rhee SJ , et al. Predicting aneurysm enlargement in patients with persistent type II endoleaks. J Vasc Surg. 2004;39(6):1157-1162.

Jones JE , Atkins MD , Brewster DC , et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007;46(1):1-8.

Steinmetz E. , Rubin BG , Sanchez LA , et al. 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.

Silverberg D. , Baril DT , Ellozy SH , et al. An 8-year experience with type II endoleaks: natural history suggests selective intervention is a safe approach . J Vasc Surg. 2006;44(3): 453-459.

Sampaio SM , Shin SH , Panneton JM , et al. Intraoperative endoleak during EVAR: frequency, nature, and significance. Vasc Endovascular Surg. 2009 ;43(4):352-359.

10.

Baum RA , Carpenter JP , Golden MA , et al. Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques. J Vasc Surg. 2002;35(1):23-29.

11.

Gambaro E. , Abou-Zamzam AM Jr , Teruya TH , Bianchi C. , Hopewell J. , Ballard JL Ischemic colitis following translumbar thrombin injection for treatment of endoleak. Ann Vasc Surg. 2004;18(1):74-78.

12.

Parry DJ , Kessel DO , Robertson I. , et al. Type II endoleaks: predictable, preventable, and sometimes treatable? J Vasc Surg. 2002;36(1):105-110.