Obliterative Endoaneurysmorrhaphy with Stent Graft Preservation for Treatment of Type II Progressive Endoleak

Abstract

Objective/background: Persistent type II endoleak (EL II) with sac enlargement after endovascular repair of abdominal aortic aneurysm requires treatment to prevent rupture. Embolization is not always effective. Conversion to open repair with stent graft (SG) explantation is a high risk option. The aim of this study was to evaluate the feasibility and immediate results of an alternative technique combining obliterative endoaneurysmorrhaphy (OEA) with SG preservation.

Methods: The open surgical technique combined sacotomy, ligation of all patent back-bleeding vessels and SG preservation. The aneurysmal shell was tightly closed over the SG to protect it from the intestines. An intra-aortic occlusion balloon was used when clamping was required.

Results: Twelve patients were treated with the OEA technique at Amiens University Hospital. All 12 procedures were successful. Four patients had previously undergone unsuccessful transarterial or translumbar embolization. Aortic clamping was performed in four cases. No SG migration or graft dislocation was observed. Follow up computed tomography scan at a median of 12 months showed shrinkage of the aneurysm sac with stable diameters and no recurrence of EL II in all cases.

Conclusion: The OEA technique is an alternative option for the treatment of progressive EL II, which can be particularly useful after failure of embolization.

Keywords: EVAR; Endoaneurysmorrhaphy; Sac enlargement; Stent graft explantation; Type 2 endoleak.