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

E Dinoto; F Ferlito; F Urso; S Evola; G Bajardi; F Pecoraro

doi:10.1016/j.ijscr.2021.106238

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

Int J Surg Case Rep. 2021 Aug:85:106238. doi: 10.1016/j.ijscr.2021.106238. Epub 2021 Jul 26.

Authors

E Dinoto¹, F Ferlito², F Urso², S Evola³, G Bajardi⁴, F Pecoraro⁴

Affiliations

¹ Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy. Electronic address: ettoredinoto@gmail.com.
² Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
³ Unit of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) 'G. D'Alessandro', University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.
⁴ Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.

Abstract

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.

Keywords: Aneurysm; Case report; Coil embolization; Endoleak type 2.