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).

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.
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.
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.
DP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult.
AuthorsYukihisa Ogawa, Shingo Hamaguchi, Hiroshi Nishimaki, Yuri Kon, Kiyoshi Chiba, Yuka Sakurai, Kenji Murakami, Yasunori Arai, Takeshi Miyairi, Yasuo Nakajima
JournalCardiovascular and interventional radiology (Cardiovasc Intervent Radiol) Vol. 38 Issue 3 Pg. 731-5 (Jun 2015) ISSN: 1432-086X [Electronic] United States
PMID25737457 (Publication Type: Journal Article)

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