A Case of Effective Zone 0 TEVAR Using Squid-Capture Assisted in situ Stent-Graft Fenestration, for Endoleak from the Fenestration of Najuta / 日本心臓血管外科学会雑誌

We report the case of a 76-year-old man who developed type IA endoleak through the fenestration after 1-debranch TEVAR using a Najuta endograft. The patient was admitted with expansion of the aneurysm after TEVAR, for additional therapy. Type IA endoleak through a fenestration has remained a significant clinical concern and its treatment is challenging. We performed Zone 0 TEVAR using the “Squid-Capture” technique assisted in situ stent-graft fenestration. Cerebral vessels were perfused by a percutaneous cardiopulmonary support system during in situ stent-graft fenestration, and the cerebral branch was clamped at the proximal site. It is difficult to operate the catheter inside the endoskeleton structure of a Najuta endograft, but several innovations were effective. Test dilation of the balloon catheter was performed to ensure that the wire did not interfere with the endoskeleton. Avoiding interference with the endoskeleton is important. The Squid-Capture technique allows safe and secure puncture of the graft. The operation was completed successfully. After this procedure, the endoleak disappeared. It is considered to be a useful method for treatment of endoleak through the fenestration.

Two Cases of Successful Treatment of Percutaneous Transarterial Embolization via Costocervical Trunk Approach for Patients with Persistent Type II Endoleak and Sac Enlargement of Arch Aneurysm after Thoracic Endovascular Aortic Repair (TEVAR) / 日本心臓血管外科学会雑誌

Among the less reported complications after thoracic endovascular aortic repair (TEVAR) is type II endoleak (T2EL). The intercostal and bronchial artery are known as feeder vessels to T2EL after TEVAR. We experienced two cases of successful treatment of percutaneous transarterial feeder vessels embolization via right costocervical trunk approach for patients with persistent T2EL and sac enlargement of an arch aneurysm after TEVAR. The costocervical trunk route is possible for key vessels to construct a collateral pathway to feeder vessels of the endoleak nidus of T2EL after TEVAR procedures for aortic arch aneurysm. A preembolizational Catheter-Directed CT angiogram (CTA) can be helpful to prevent harmful complications (e.g., spinal cord infarction).

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient / Uma nova técnica assistida por balão para assegurar a cateterização visceral durante o reparo endovascular, com a técnica de chaminé, de um aneurisma de aorta roto em um paciente centenário

Abstract A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Resumo Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.

Risk factors and outcomes of endoleak after endovascular aneurysm repair / 中华普通外科杂志

Objective:To analyze the risk factors and prognosis of endoleak after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm.Methods:The clinical data of patients with infrarenal abdominal aortic aneurysms treated by endovascular repair at the Department of Vascular Surgery,the First Affiliated Hospital of Guangxi Medical University from Jun 2012 to Nov 2021 were retrospectively analyzed.Results:During the first follow-up CTA after surgery,136 out of 299 patients had endoleak.A total of 186 patients had at least one CTA reexamination after discharge. Statistical analysis showed that excessive neck angulation was an independent risk factor for type Ⅰa endoleak ( t=-6.108, P<0.001), wider common iliac artery diameter (left Z=-2.787, P=0.005, Right Z=-2.381, P=0.017) and iliac aneurysm ( χ2=6.398, P=0.011) were risk factors for type Ⅰb endoleak. The survival time of patients in endoleak group was similar to no endoleak group. Conclusions:Excessive neck angulation is an independent risk factor for type Ⅰa endoleak. Most leaks resolve spontaneously ,the prognosis is fair.

Aortic banding for refractory endoleaks after endovascular abdominal aortic aneurysm repair / 中华普通外科杂志

Objective:To summarize the safety and efficacy of aortic banding in the treatment of refractory endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).Methods:The clinical and follow-up data of 10 patients with refractory endoleaks EVAR undergoing aortic banding at Peking University People's Hospital from Jun 2019 to Aprl 2022 were retrospectively analyzed.Results:The aortic banding was indicated for type Ⅰ endoleak in 6 patients, type Ⅱ endoleak in 3 patients and internal tension in 1 patient with persistent aneurysm enlargement or rupture. The surgical procedure was based on laparotomy. The proximal aortic neck was exposed and re-fixation with artificial strip to prevent bleeding. The surgical procedures was successful in all the 10 cases without residual endoleak or re-bleeding. The post-operative contrast-enhanced ultrasonography revealed neither new-onset endoleak nor occlusion of stent-grafts. Perioperative complications included one case of delayed wound healing and one case of incomplete ileus. No perioperative deaths occurred. Midterm follow-up was achieved in 10 patients with a mean follow-up time of 13 months. No recurrence of endoleak was found. One patient underwent endovascular repair for independent thoracic aortic aneurysm 6 months after surgery. There were no other aorta-related secondary surgeries or aortic-related deaths.Conclusion:Aortic banding for refractory endoleaks after EVAR is minimally invasive and reliable. It can effectively eliminate the refractory endoleaks, and reduce the risks of aortic-related secondary surgery or death.

Multi-channel embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair / 中华普通外科杂志

Objective:To evaluate multi-channel transcatheter embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair (EVAR).Methods:Data of 8 cases of type Ⅱ endoleak after EVAR from Oct 2017 to Nov 2020 at the Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital were retrospectively analyzed.Results:All patients who suffered from type Ⅱ endoleak that originated from lumbar arteries after EVAR were successfully treated with coils and mixture of Compant medical glue and iodipin through multi-channel. The technical success rate was 100%, the operative time was 80-150 min. Right lower limb dyskinesia occurred in 1 patient after operation, the symptom disappeared by anticoagulation and trophic neurotherapy for 2 months. Type Ⅱ endoleak didn't recur in all patients, and no mortality during the 4-38(14.1) months follow-up period.Conclusion:Multi-channel transcatheter embolotherapy has definite effects for the treatment of type Ⅱ endoleak from lumbar arteries after EVAR, with high technical feasibility, few perioperative complications, low mortality among other advantages. The results of short and medium term are satisfactory.

Chimney stent in acute Stanford type B aortic dissection with insufficient anchorage zone / 中华普通外科杂志

Objective:To investigate the effect of chimney stent for reconstruction of left subclavical artery (LSA) in thoracic endovascular aotic repair (TEVAR) for acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen.Methods:TEVAR with chimney stent for LSA in 39 cases of acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen was done from Feb 2013 to Jan 2021.Results:Covered chimney stents was used in 11 cases and bare chimney stents in 28 cases. There was no postoperative stroke, left upper limb ischemia, paraplegia, hemiplegia and death. No stent migration, reverse tear and dissection rupture were observed. One bare stent was obstructed after 18 months, and all the remaining stents were patent during follow-up. The rate of immediate type Ⅰa endoleak in covered chimney stent group and bare chimney stent group were 0(0/11) and 32.1%(9/28) respectively ( P=0.04). The distance from proximal tear to LSA in covered chimney stent group, endoleak subgroup and non-endoleak subgroup in bare chimney stent were (5.1±2.3)mm, (14.4±5.2)mm and (7.8±7.0)mm respectively ( P<0.05). False lumen thrombosis was formed in endoleak subgroup 2-8 weeks after operation, and endoleak disappeared. Conclusions:There is a correlation between immediate type Ⅰa endoleak in bare chimney stent for LSA and the distance from proximal tear to LSA, covered chimney stent can reduce the incidence of immediate type Ⅰa endoleak in TEVAR for acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen.

Transcaval access to the abdominal aorta: indications of interest to surgeons and a comprehensive literature review

Abstract We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.

Ultrasonic diagnosis of endoleak after endovascular graft exclusion for abdominal aortic aneurysm / 中国介入影像与治疗学

Objective: Abdominal aortic aneurysm is mainly treated with endovascular aortic repair (EVAR), but the incidence of endoleak after EVAR is high. The main purpose of follow-up is to monitor the occurrence of endoleak after EVAR. Ultrasonic examinations have the advantages of convenient operation, low price, no ionizing radiation and high sensitivity and specificity for detecting endoleak. The advancements of ultrasonography in detecting endoleak after EVAR were reviewed in this article.

Use of carbon dioxide for therapeutic decision-making in endoleaks: a case report / Uso de CO2 na tomada de decisão terapêutica de endoleak: relato de caso

Abstract Endovascular aneurysm repair is currently the most frequently treatment modality for infrarenal aortic aneurysms. Endoleaks are the most common cause of reintervention after endovascular aneurysm repair. It is often unclear which type of endoleak is the correct diagnose, making the treatment decision difficult. We report the case of a 72-year-old man with an endoleak two years after endovascular aneurysm repair. Images suggested a type III endoleak, but this was not confirmed by contrast aortography. We proceeded with the investigation using aortography with carbon dioxide and observed a type IA endoleak. This was successfully treated by implantation of a proximal cuff. A review of the literature shows that the role of carbon dioxide in endoleak management is still unclear. We present a case in which carbon dioxide was essential to both diagnosis and therapeutic decision-making in a type IA endoleak.

Resumo O tratamento endovascular dos aneurismas de aorta abdominal é atualmente a modalidade de tratamento mais comum. Os endoleaks representam a causa mais frequente de reintervenção após o tratamento endovascular. O diagnóstico do tipo de endoleak frequentemente é incerto, tornando o tratamento desafiador. Apresentamos o caso de um paciente de 72 anos, com endoleak após 2 anos de tratamento endovascular de aneurisma de aorta abdominal. Os exames de imagem pré-operatórios sugeriam um endoleak tipo III; entretanto, durante aortografia com contraste iodado, não foi possível identificá-lo. Optamos por realizar aortografia com dióxido de carbono (CO2), sendo, então, identificado um endoleak tipo IA, que foi tratado com sucesso com o uso de uma extensão (cuff) proximal. O papel do CO2 no diagnóstico de endoleaks ainda não está claro. Relatamos um caso em que o uso do CO2 foi essencial para o diagnóstico e para a decisão de tratamento do endoleak tipo IA.

Anticoagulación oral en reintervenciones endovasculares de la aorta / Oral Anticoagulation in Endovascular Aortic Reinterventions

RESUMEN Introducción: La endofuga es la principal causa de reintervención después del tratamiento endovascular de aorta. Algunos pacientes necesitan anticoagulación oral prolongada, lo cual puede aumentar la incidencia de endofugas posoperatorias. Objetivos: Nuestro objetivo es determinar si la anticoagulación oral posoperatoria tiene impacto en la incidencia de endofugas. Material y métodos: Este análisis retrospectivo incluyó todos los pacientes con aneurisma de aorta abdominal tratados por vía endovascular entre 2009 y 2014 en nuestro centro. Se determinaron dos grupos de pacientes de acuerdo con la necesidad de anticoagulación oral y se comparó entre ambos grupos la mortalidad relacionada con la aorta; la supervivencia libre de reintervenciones, de cualquier endofuga y de endofugas no tipo II; supervivencia libre de un punto final compuesto por mortalidad relacionada con la aorta, reintervenciones y endofugas, y la reducción del diámetro del saco aneurismático. Resultados: De 341 pacientes tratados, 33 (9,67%) estaban anticoagulados. No hubo diferencias entre ambos grupos en términos de mortalidad relacionada con la aorta (2,59% vs. 3,03%, p = ns), supervivencia libre de reintervenciones (84,04% vs. 86,2%; p = ns), supervivencia libre de cualquier endofuga (82% vs. 89%; p = 0,81) o supervivencia libre de endofugas no tipo II (88% vs. 88%; p = 0,52). Al analizar la supervivencia libre del punto final compuesto tampoco se encontraron diferencias significativas (80% vs. 85%; p = ns). La reducción promedio del diámetro del saco aneurismático fue de 5,19 mm y 3,51 mm (p = 0,2). Conclusiones: No se registró diferencia en ninguno de los resultados analizados. La anticoagulación oral posoperatoria no tuvo impacto en los resultados del tratamiento endovascular de aorta.

ABSTRACT Introduction: Endoleak is the main cause for reintervention after endovascular aortic repair. Some patientis need prolonged oral anticoagulation, which may increase the incidence of postoperative endoleaks. Objectives: Our objective was to determine whether postoperative oral anticoagulation has an impact on the incidence of endoleaks. Methods: This retrospective analysis included all patientis with endovascular treatment of abdominal aortic aneurysm at our center between 2009 and 2014. Two groups of patientis were determined according to the need for oral anticoagulation. Aortic-related mortality, survival free from reinterventions, any endoleak and non-type II endoleaks, survival free of the composite endpoint of mortality associated with the aorta, reinterventions and endoleaks, and reduction of aneurysmal sac diameter was compared between both groups.Resultis: Among 341 treated patientis, 33 (9.67%) were anticoagulated. There were no differences between the two groups in terms of aorta-related mortality (2.59% vs. 3.03%, p=ns), reintervention-free survival (84.04% vs. 86.2%; p=ns), any endoleak- free survival (82% vs. 89%, p=0.81) or non-type II endoleak-free survival (88% vs. 88%, p=0.52). Similarly, no significant differences were found when analyzing the composite endpoint-free survival (80% vs. 85%, p=ns). The average reduction of aneurysmal sac diameter was 5.19 mm and 3.51 mm (p=0.2). Conclusions: No difference was registered in any of the resultis analyzed. Postoperative oral anticoagulation had no impact on the resultis of endovascular aortic treatment.

Fate of Pure Type II Endoleaks Following Endovascular Aneurysm Repair

PURPOSE: Type II endoleaks (T2ELs) are the most common type of endoleaks observed after endovascular aneurysm repair (EVAR). However, whether T2ELs should be treated remains debatable. In the present study, we aimed to describe the natural course of T2ELs and suggest the direction of their management. MATERIALS AND METHODS: We reviewed the data of 383 patients who underwent EVAR between 2007 and 2016. Data, including demographic and anatomical details, were collected, and patients with T2ELs were compared to those without them. Patients with T2ELs were categorized into subgroups according to changes in sac size and treatment requirement. RESULTS: We found patent lumbar artery count and lesser thickness of mural thrombi to be significant risk factors for T2ELs. Among the 383 patients, 85 (22.2%) patients were diagnosed with pure T2ELs. Among these 85 patients, the sac size increased in 29 (34.1%) patients, showed no significant change in 39 (45.9%) patients, and decreased in 17 (20.0%) patients. Fifteen (17.6%) patients, among 85 with initial pure T2ELs, showed spontaneous resolution. Five (5.9%) patients among 29, in whom the sac size increased, developed combined-type endoleaks. No sac ruptures were noted among the patients with T2ELs. CONCLUSION: T2ELs with sac expansion potentially contribute to other types of endoleaks. Therefore, periodic screening is important for these patients, particularly for those showing an increasing sac size. In addition, intervention should be considered when other types of endoleaks occur.

Stent Graft Implantation and Superselective Embolization with Liquid Embolic Agent, Onyx for Iatrogenic Common Iliac Artery Pseudoaneurysm and Persistant Endoleak

A 68-year-old male patient with a history of femoro-femoral bypass following unsuccessful intervention for chronic total iliac occlusion was found to have a saccular pseudoaneurysm of the right common iliac artery (CIA) due to interventional device-related injuries associated with the past endovascular intervention. An iatrogenic pseudoaneurysm in the CIA is generally asymptomatic, but it has a high risk of rupture, regardless of its size or symptoms. Endovascular therapy may be the best treatment option; however, ineffective sealing with a stent graft may lead to a type I endoleak. Under such conditions, use of the liquid embolic agent, Onyx, as a bailout solution for the type 1 endoleak is promising.

Mid-Term Results of Using the Seal Thoracic Stent Graft in Cases of Aortopathy: A Single-Institution Experience / 대한흉부외과학회지

BACKGROUND: The endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft. METHODS: We retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications. RESULTS: Among 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was 37.86±30.73 months (range, 0–124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively. CONCLUSION: The use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.

Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan

PURPOSE: The outcomes of endovascular aneurysmal repair (EVAR) for infrarenal abdominal aortic aneurysms (AAAs) in the Middle East have rarely been reported. We analyzed the outcomes of EVAR in a Jordanian population.MATERIALS AND METHODS: We conducted a retrospective review of the medical records of patients with infrarenal AAA who were treated with elective EVAR between January 2004 and January 2017 at a single center in Jordan. Patient characteristics, anatomical characteristics, procedural details, and early and late postoperative outcomes were analyzed.RESULTS: A total of 288 patients (mean age, 70 years; 77.8% males) underwent EVAR for infrarenal AAA (median aneurysm size, 64 mm). Bifurcated endografts were used in 265 patients, and aorto-uni-iliac devices were used in 22 patients. Successful endograft deployment was achieved in all patients with no open conversion. Early complications included localized groin hematoma in 15, femoral artery dissection in 4, wound infection in 3, and seroma in 3 patients. With a mean follow-up of 60 months, 50 endoleaks were detected, including 9 type I, 38 type II, and 3 type III. Seven patients had unilateral graft limb occlusion. The 30-day mortality was 1.7%, and long-term mortality was 7.0%, mostly due to non-AAA-related causes.CONCLUSION: EVAR was safely performed in Jordanian patients with minimal complications. However, long-term surveillance is important due to the risk of endoleaks and consequent intervention.

Intraoperative sac coiling embolization in type Ⅱ endoleak high-risk population after endovascular aortic repair / 中华普通外科杂志

Objective@#To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair(EVAR).@*Methods@#From Jan 2014 to Jan 2018, one hundred and twelve consecutive patients with infra-renal AAA were enrolled for this study, There were 76 patients undergoing standard EVAR (standard-group)and 36 patients doing aneurysmal sac coiling embolization (embo-group). Baseline characteristics, aneurysmal sac parameters, radiological intervention details and follow up results were recorded.@*Results@#Mean follow-up time was 25.9 m for embo-group. During follow-up period, no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported. A mean of (2.72±1.16) coils (range 1-7) was used in the embo-group. The incidence of type Ⅱ endoleak was 30.3%(23/76) in standard-group and 11.1%(4/36) in embo-group(χ2=4.90, P=0.027). Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume≥128 cm3. In the subgroup analysis (sac volume≥128 cm3), the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group (χ2=6.07, P=0.014).@*Conclusion@#Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak. This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.

Intraoperative sac coiling embolization in type Ⅱ endoleak high-risk population after endovascular aortic repair / 中华普通外科杂志

Objective To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair (EVAR).Methods From Jan 2014 to Jan 2018,one hundred and twelve consecutive patients with infrarenal AAA were enrolled for this study,There were 76 patients undergoing standard EVAR (standard-group) and 36 patients doing aneurysmal sac coiling embolization (embo-group).Baseline characteristics,aneurysmal sac parameters,radiological intervention details and follow up results were recorded.Results Mean follow-up time was 25.9 m for embo-group.During follow-up period,no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported.A mean of (2.72 ± 1.16) coils (range 1-7) was used in the embo-group.The incidence of type Ⅱ endoleak was 30.3％ (23/76) in standard-group and 11.1％ (4/36) in embo-group(x2 =4.90,P =0.027).Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume ≥ 128 cm3.In the subgroup analysis (sac volume≥ 128 cm3),the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group (x2 =6.07,P =0.014).Conclusion Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak.This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.

Tratamento de endoleak tipo 1A mediante embolização com molas: relato de caso / Treatment of type 1A endoleak using coil embolization: a case report

No endoleak tipo 1A, a endoprótese não sela completamente o colo do aneurisma proximal, e o fluxo arterial está presente entre a parede do colo aórtico e o material do implante. Este é um relato de um caso no qual foi utilizada embolização com molas, associado a uma revisão de literatura (PubMed, LILACS e SciELO). Foram pesquisados artigos publicados nos últimos 5 anos com os descritores "endoleak 1A", "coil embolization" e "treatment", combinados de formas aleatórias, sendo encontrados 25 artigos. O tipo 1A ocorre em 1,1% dos pacientes após 30 dias do implante. O tratamento consiste em aumentar a vedação do implante proximal, principalmente com o uso de stents e balões para alargar a zona de aterragem ou aumentar a força radial do implante. Alguns trabalhos sugerem técnicas de embolização com cianoacrilato, cola de fibrina e uso de Onyx, mostrando taxas de sucesso superiores a 97%. Contudo, a correção de endoleaks tipo 1A mediante embolização com molas é pouco descrita

In a type 1A endoleak, the endograft is unable to fully seal the proximal aneurysm neck and blood flow leaks between the wall of the aortic neck and the graft material. This article reports a case in which coil embolization was used and presents a literature review (PubMed, LILACS, and SciELO). Searches were run for articles published in the past 5 years using the descriptors "endoleak 1A", "coil embolization," and "treatment". Type 1A endoleak occurs in 1.1% of patients within 30 days of graft placement. Treatment of an endoleak is obligatory and usually consists of sealing the proximal graft neck using stents and balloons to expand the landing zone or to increase the radial force of the graft. Some studies have suggested using embolization techniques with cyanoacrylate, fibrin glue, and Onyx, demonstrating success rates that exceed 97%. However, correction of type 1A endoleak using coil embolization has seldom been described

Incidence and Factors Associated with Aortic SAC Reduction after Evar in Spanish Population

Introduction: This study aimed to know the incidence and factors associated with aneurysmal sac reduction (ASR) after endovascular aneurysm repair (EVAR) at 3 years of follow up in the Spanish population. Material and Methods: This is a retrospective observational study. We analyzed all patients with abdominal aortic and aortoiliac aneurysms who underwent elective EVAR in our hospital between January 2007 and September 2015. We studied ASR incidence at 3 years of follow-up. ASR was defined as a reduction in sac diameter ≥ 5 mm. Multiple preoperative and postoperative variables were analyzed. We used chi2 and T student tests for statistical analysis. Kaplan-Meier survival analysis and actuarial analysis were performed. Results: Three hundred one patients underwent EVAR. The majority was men (97.3%) with a mean age of 74 ± 8 years, and 77.4% were at high surgical risk according to the American Society of Anesthesiologists classification (ASA). There was an incidence of 51.6% ASR at 3 years of follow up. Patients under chronic anticoagulation had 60% ASR vs 50.5%, p = 0.489. An aortic neck> 20 mm in length was associated with 55.3% ASR vs 45.7%, p = 0.303. Patients with ASR were younger 71 ± 8 years vs 76 ± 6 years, (P = 0.001, 95% CI, -7-1.9). Type II endoleak was associated with lower ASR, 32.4% vs 60, 8%, p = 0.006. Overall survival at 6, 12, 24 and 36 months was 90%, 82%, 71% and 61%, respectively. Survival in patients with ASR was better than patients without ASR, p = 0.008. Conclusions: ASR incidence after EVAR was high in our series and was associated with increased survival rate. The overall survival at medium term was good despite the high surgical risk of our series.