ABSTRACT
BACKGROUND: Intraprocedural aneurysm sac embolization (embo-EVAR) during endovascular abdominal aneurysm repair (EVAR) using coils and fibrin glue is a technique for preventing type II endoleak (EII). Our aim is to evaluate feasibility, safety and clinical outcome of this promising approach. MATERIALS AND METHODS: A retrospective clinical case analysis of 72 patients who underwent EVAR during the period 2011-2014. Two groups were compared at 6 and 12 months follow-up with contrast media computed tomography scan and contrast-enhanced ultrasound (CEUS) imaging: consecutively, 36 patients (group A) treated with classic EVAR and 36 patients (group B) treated with embo-EVAR. Coils were released filling better as possible the aneurysm sac; the embolization was completed by injecting fibrin glue. Device and materials used, differential systemic and sac pressures, presence of any endoleak, and complication were registered. RESULTS: In our experience, we had 100% technical success without surgical conversion. Embo-EVAR was performed, after endograft deployment, in group B patients, all with ratio of Δ-pressures (obtained from Δ-sac pressure/Δ-differential pressure) > 0.16. No early or late complications occurred and mortality was nil. Follow-up was performed with computed tomography-angiography and CEUS at 6 and 12 months. We observed 9 type II and 1 type Ia endoleak in group A and 2 type II and 1 type Ib endoleaks in group B. Mean radiation exposure time was 30.3 min in group A and 43.3 min in group B. EVAR procedure average cost was 9,000 . The average cost of sac embolization was 1,500. CONCLUSIONS: Although a randomized study is necessary, embo-EVAR may be a valid approach to prevent type II endoleaks and further complications. Mild costs and exposure-dose increase could be accepted to avoid reinterventions, and in our experience, it could be routinely performed with excellent results.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Embolization, Therapeutic , Endoleak/prevention & control , Endovascular Procedures/methods , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/economics , Aortic Aneurysm, Abdominal/mortality , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/economics , Blood Vessel Prosthesis Implantation/mortality , Computed Tomography Angiography , Contrast Media/administration & dosage , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/economics , Embolization, Therapeutic/mortality , Endoleak/diagnostic imaging , Endoleak/etiology , Endoleak/mortality , Endovascular Procedures/adverse effects , Endovascular Procedures/economics , Endovascular Procedures/mortality , Feasibility Studies , Female , Hospital Costs , Humans , Italy , Male , Middle Aged , Radiation Dosage , Radiation Exposure , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , UltrasonographyABSTRACT
PURPOSE: To report the use of a new type of uncovered stent to treat aortic aneurysms. CASE REPORT: Under compassionate use, an 81-year-old man with multiple comorbidities and an expanding 63-mm juxtarenal abdominal aortic aneurysm was treated with a 28×100-mm Multilayer flow-modulating stent. Immediately, the blood flow velocity inside the aneurysm sac appeared reduced on fluoroscopy. All aortic branches covered by the stent (celiac trunk, superior mesenteric artery, and renal arteries) remained patent. Serial computed tomography at up to 12 months has shown excellent stent and visceral artery patency and progressive reduction in the sac diameter (58 mm) and volume (84.9 cm(3) to 82.8 cm(3)). CONCLUSION: This case shows that the use of an uncovered multilayer stent reduces the flow in the aneurysm but preserves perfusion of the branch arteries, which is impossible with covered stents.
