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Direct Sac Access with Embolization of a Type 2 Endoleak Nidus Can Stabilize Growing Aneurysms After EVAR

OBJECTIVES: We reviewed our experience with transfemoral and translumbar intrasac access for embolization of type 2 endoleaks in growing aneurysms after EVAR.
METHODS: We identified 8 EVAR patients(mean age 75±5 years, all male) treated by intrasac access and embolization in the postoperative period. All 8 had isolated type 2 endoleaks on computed tomography scans and aneurysmal growth greater than 5 mm. A transfemoral approach was used to gain access to the sac in 3 patients and a translumbar approach was used in 5. In 3 patients, both coils and glue(cyanoacrolate) were placed into the endoleak nidus and outflow branches. One patient had coils alone placed in the outflow branches and endoleak nidus. Two patients had coils and glue placed in the endoleak nidus alone as the outflow vessels were not accessible. In the 2 remaining patients, there was no endoleak identified on angiogram and coils were placed blindly into the aneurysm sac.
RESULTS: Mean aneurysm size at the time of the original repair was 6.0cm±0.8cm. Mean aneurysm size prior to embolization at a mean of 23±12 months postprocedure was 6.9cm±0.8cm(mean increase in size of 0.8cm±0.5cm). The 2 patients without an identifiable endoleak on angiogram had continued growth and required open ligation of lumbar vessels at 7 and 12 months post the embolization attempt. The remaining 6 patients had resolution of the endoleak, and stable or shrinking aneurysms at a mean follow-up of 14±10 months(range 4-38 months) post-embolization.
CONCLUSIONS: Intrasac coil and glue embolization of isolated type 2 endoleaks can effectively stabilize the growth of aneurysms after EVAR at midterm. When the endoleak nidus cannot be identified on angiogram, blind sac embolization does not appear to be effective.