Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR).

Abstract

BACKGROUND:

Endovascular aortic repair (EVAR) requires further intervention in 20-30 % of cases, often due to type II endoleak (T2EL). Management options for T2EL include transarterial embolization, direct puncture (DP), or transcaval embolization. We report the case of an 80-year-old man with T2EL who successfully underwent DP embolization.

METHODS:

Embolization by DP was performed with a transpedicular approach using an isocenter puncture (ISOP) method. An isocenter marker (ICM) was placed at a site corresponding to the aneurysm sac on fluoroscopy in two directions (frontal and lateral views). A vertebroplasty needle was inserted tangentially to the ICM under fluoroscopy and advanced to the anterior wall of the vertebral body. A 20 cm-length, 20-G-PTCD needle was inserted through the outer needle of the 13-G needle and advanced to the ICM. Sac embolization using 25 % N-buty-2-cyanoacrylate diluted with Lipiodol was performed. After complete embolization, rotational DA confirmed good filling of the sac with Lipiodol. The outer cannula and 13-G needle were removed and the procedure was completed.

RESULTS:

The patient was discharged the next day. Contrast-enhanced computed tomography 1 and 8 months later showed no Lipiodol washout in the aneurysm sac, no endoleak recurrence, and no expansion of the excluded aneurysm.

CONCLUSION:

DP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult.

• Authors: Yukihisa Ogawa, Shingo Hamaguchi, Hiroshi Nishimaki, Yuri Kon, Kiyoshi Chiba, Yuka Sakurai, Kenji Murakami, Yasunori Arai, Takeshi Miyairi, Yasuo Nakajima
• Journal: Cardiovascular and interventional radiology (Cardiovasc Intervent Radiol) Vol. 38 Issue 3 Pg. 731-5 (Jun 2015) ISSN: 1432-086X [Electronic] United States
• PMID: 25737457 (Publication Type: Case Reports, Journal Article)

Topics

• Aged, 80 and over
• Aortic Aneurysm, Abdominal (surgery)
• Blood Vessel Prosthesis
• Embolization, Therapeutic (instrumentation, methods)
• Endoleak (therapy)
• Endovascular Procedures
• Humans
• Male
• Postoperative Complications (therapy)
• Punctures (instrumentation, methods)
• Treatment Outcome