Type 1A endoleak detachable coil embolization after endovascular aneurysm sealing: Case report

Outcome Analysis of Speed Gate Cannulation during Standard Infrarenal Endovascular Aneurysm Repair

BACKGROUND

Endovascular aortic repair (EVAR) is generally performed with bi/trimodular stent-grafts requiring retrograde contralateral gate cannulation (CGC). In the case of tricky CGC, an increased EVAR procedural time and radiation exposure have been reported. Herein, we compare the outcomes of conventional CGC and CGC using the speed gate cannulation (SGC) technique in standard EVAR for a propensity-matched cohort.

METHODS

A total of 371 patients were retrospectively analyzed. Inclusion criteria were fulfilled in 172 patients who underwent propensity score matching. Primary outcomes included operative time, CGC time, mean contrast medium, fluoroscopy time, and CGC fluoroscopy time.

RESULTS

After matching, 78 patients were included in each group (SGC vs. standard). Primary outcomes registered a significant reduction in CGC time (4 [1-6] vs. 8 [6-14] min; p = 0.001) and fluoroscopy time (12 [9-16] vs. 17 [12-25] min).

CONCLUSIONS

In this preliminary experiment, the use of SGC was feasible with no significant registered postoperative complications. A significant reduction in contrast medium usage, radiation exposure, and CGC time was observed with the use of SGC. SGC is a simple adjunctive technique, and its use should be considered in standard EVAR, especially in emergency scenarios, where time is of the essence.

Trans-limb embolization for treatment of Type 2 endoleak post EVAR: Case report

Introduction

Type 2 endoleaks (T2EL) occur after 10%–25% of endovascular abdominal aortic aneurysm repairs and increase the risk factor of endograft repair failure and rupture. Herein we report a case of endovascular treatment of T2EL where we performed a trans-limb embolization.

Presentation of case

A 63-years-old male previously treated for AAA with endovascular aortic aneurysms repair (EVAR), showed an angio-CT scan followup with a type 2 endoleak fed from inferior mesenteric artery (AMI) with growth of AAA greater of 1 cm than preoperative CT-scan and increase of chronic lumbar pain. Due to high risk of rupture was performed a trans-limb embolization with complete sealing. The 6 months CT-angiography showed complete type 2 endoleak exclusion without changes of AAA.

Discussion

The risk of aneurysm rupture in the presence of an isolated T2EL is exceptionally low. However, when a persistent T2EL is associated with a significant sac size increase, commonly considered as at least 5 mm over 6 months, should be treated. Detachable coils are repositionable, allowing an extremely precise deployment and subsequent embolization of different targets.

Conclusion

In this experience trans-limb embolization was feasible and this tool should be taken in account especially when no other surgical options exists.

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Type 2 endoleaks (T2EL) are a risk factor for endograft repair failure and rupture.

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T2EL are the most common endoleaks and remain the main cause of repeat intervention.

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Trans-limb embolization is an innovative technique for T2EL without standard access.

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Concerto are detachable coils repositionable allowing an extreme precise deployment.

TEVAR and periscope graft technique to treatment of huge aneurysm of aortic isthmus: Case report

Introduction

Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism.

Presentation of case

An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the periscope graft technique to preserve patency in left subclavian artery (LSA).

Discussion

Symptomatic ischemia from LSA coverage has been reported to occur in only a modest 6–10% of patients and is often sacrificed with impunity given coverage rates between 10 and 50%. In this case reported the lack of revascularization of LSA increased the risk of neurological manifestations or stroke. Periscope technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years.

Conclusions

Our experience using TEVAR with periscope graft technique as solution to address thoracic aneurysm of aortic isthmus was feasible and safe.

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Innovative techniques as chimney and periscope grafts can improve the outcomes of TEVAR.

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Subclavian Artery is important to vascularization of upper arm, vertebro-basilar circulation and medullar vascularization.

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Maintenance of blood flow to the LSA is recommended because it has been shown to prevent paraplegia in TEVAR procedures.

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Periscope technique is feasible and safe to maintain perfusion to the subclavian artery.