Totally Percutaneous Aneurysm Sac Embolization During Endovascular Aneurysm Repair

Three-Dimensional Printing Application in a Challenging Case of Type II Endoleak

PURPOSE

To highlight the importance of 3-dimensional (3D) arterial printing in a case of type II endoleak (EL) embolization.

CASE REPORT

An 81-year-old patient, previously treated with endovascular aortic repair (EVAR), developed a type II EL requiring treatment. The EL's main origin was the median sacral artery (MSA). Initial attempts in embolization via a transsealing and transarterial approach were unsuccessful owing to extremely tortuous arterial communications between the left hypogastric artery and the MSA. The construction of a clear resin 3D model of the aorta and iliolumbar arteries improved anatomy understanding and moreover allowed a preoperative simulation. The subsequent transarterial attempt in embolization was resolutive, significantly reducing total procedural time and radiation dose.

CONCLUSION

Printing of clear resin 3D arterial models facilitates type II EL transarterial embolization, improving anatomy understanding and allowing simple fluoroscopy-free simulations.

CLINICAL IMPACT

The aim of our work is to highlight the additional value of three-dimensional (3D) printing during preoperative planning of challenging endovascular cases. To our best knowledge, this is the first report about 3D printing use in a case of type II endoleak (EL). We believe that realizing life-size aortic models in selected cases where a complex type II EL embolization procedure is indicated, could lead to a better understanding of arterial anatomy, thus allowing to increase procedural success and reduce operative and most importantly fluoroscopy time.

A simplified method of pre-emptive perigraft aortic sac embolization to prevent type II endoleak using the Excluder endograft

Pre-emptive, nonselective perigraft embolization of abdominal aortic aneurysm sac to reduce the risk of type II endoleak has been previously reported with a percutaneous technique using contralateral access with resheathing for coiling. The approach has been modified to simplify the procedure and to eliminate unnecessary sheath exchanges.