Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000066.xml
Rofo 2021; 193(12): 1426-1435
DOI: 10.1055/a-1502-7883
DOI: 10.1055/a-1502-7883
Review
Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer
Article in several languages: English | deutsch
Abstract
Background Type 2 endoleaks (T2EL) are the most frequent complication following endovascular aortic repair. Multiple studies primarily deal with the technical and clinical success of the embolization of persisting T2EL, thereby revealing controversial outcomes. Current reports rarely focus on the detailed execution of such a complex interventional procedure with respect to the difficult anatomic setting.
Methods The present review provides an in-depth depiction and evaluation of the interventional methodology of the embolization of T2EL in the abdominal aorta with use of ethylene vinyl alcohol copolymer (EVOH). Complicating anatomic conditions are taken into account as well as technical and clinical success rates.
Results Using the transarterial approach, there are at least 4 different pathways to access the nidus of a T2EL. CT-guided direct puncture of the aneurysm sac provides an alternative method of high technical success. EVOH with its slow solidification characteristics enables good control to achieve complete filling of the T2EL. During the intervention, however, it remains difficult to meet exactly the embolization endpoint, especially in large T2ELs.
Conclusion T2EL embolization using EVOH is an effective treatment with low major complication rates when conducted by skilled interventionists with detailed knowledge of diverse complex access routes.
Key Points:
-
Many roads lead to Rome to access the nidus of a T2EL including diverse complex transarterial pathways and direct aneurysm sac puncture.
-
Ethylene vinyl alcohol co-polymer enables good control for slow filling of the nidus with low risk of major complications.
-
Identification of the embolization endpoint remains difficult during the procedure and may result in secondary interventions.
-
Successful T2EL embolization requires detailed knowledge of all access routes to the nidus and skilled handling of liquid embolics.
Citation Format
-
Nolte-Ernsting C, Mecklenbeck F, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. Fortschr Röntgenstr 2021; 193: 1426 – 1435
Publication History
Received: 03 February 2021
Accepted: 26 April 2021
Article published online:
17 June 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Rand T, Uberoi R, Cil B. et al. Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Intervent Radiol 2013; 36: 25-45
- 2 Guo Q, Du X, Zhao J. et al. Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: A meta-analysis. PLoS ONE 2017; 12: e0170600 DOI: 10.1371/journal.pone.0170600.
- 3 Sidloff DA, Gokani V, Stather PW. et al. Type II endoleak: conservative management is a safe strategy. Eur J Vasc Endovasc Surg 2014; 48: 391-399 DOI: 10.1016/j.ejvs.2014.06.035.
- 4 Ward TJ, Cohen S, Patel RS. et al. Anatomic risk factors for type-2 endoleak following EVAR: A retrospective review of preoperative CT angiography in 326 patients. Cardiovasc Intervent Radiol 2014; 37: 324-328 DOI: 10.1007/s00270-013-0646-7.
- 5 Fukuda T, Matsuda H, Sanda Y. et al. CT findings of risk factors for persistent type II endoleak from inferior mesenteric artery to determine indicators of preoperative IMA embolization. Ann Vasc Dis 2014; 7: 274-279 DOI: 10.3400/avd.oa.14-00008.
- 6 Löwenthal D, Herzog L, Rogits B. et al. Identification of predictive CT angiographic factors in the developmenr of high-risk type 2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms. Fortschr Röntgenstr 2015; 187: 49-55 DOI: 10.1055/s-0034-1385123.
- 7 Seike Y, Matsuda H, Fukuda T. et al. The influence of 4 or more patent lumbar arteries on persistent type II endoleak and sac expansion after endovascular aortic repair. Ann VAsc Surg 2018; 50: 195-201 DOI: 10.1016/j.avsg.2017.12.014.
- 8 Li B, Montbriand J, Eisenberg N. et al. Pre-operative aneurysm thrombus volume, but not density, predicts type 2 endoleak rate following endovascular aneurysm repair. Ann Vasc Surg 2019; 57: 98-108 DOI: 10.1016/j.avsg.2018.09.012.
- 9 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas. 07.07.2018. https://www.awmf.org/leitlinien/detail/ll/004-014.html
- 10 Chaikof EL, Dalman RL, Eskandari MK. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67: 2-77.e2 DOI: 10.1016/j.jvs.2017.10.044.
- 11 Wanhainen A, Verzini F, Van Herzeele I. et al. European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57: 8-93 DOI: 10.1016/j.ejvs.2018.09.020.
- 12 Jones JE, Atkins MD, Brewster DC. et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg 2007; 46: 1-8 DOI: 10.1016/j.jvs.2007.02.073.
- 13 Dudeck O, Schnappauff D, Herzog L. et al. Can early computed tomography angiography after endovascular aortic aneurysm repair predict the need for reintervention in patients with type II endoleak?. Cardiovasc Intervent Radiol 2015; 38: 45-52 DOI: 10.1007/s00270-014-0901-6.
- 14 Chung R, Morgan RA. Type 2 endoleaks post-EVAR: current evidence for rupture risk, intervention ans outcomes of treatment. Cardiovasc Intervent Radiol 2015; 38: 507-522 DOI: 10.1007/s00270-014-0987-x.
- 15 Dingemans SA, Jonker FHW, Moll FL. et al. Aneurysm sac enlargement after endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2016; 31: 229-238 DOI: 10.1016/j.avsg.2015.08.011.
- 16 Moulakakis KG, Klonaris C, Kakisis J. et al. Treatment of Type II Endoleak and Aneurysm Expansion after EVAR. Ann Vasc Surg 2017; 39: 56-66 DOI: 10.1016/j.avsg.2016.08.029.
- 17 Marcelin C, le Bras Y, Petipierre F. et al. Safety and efficacy of embolization using Onyx of persistent type II Endoleaks after abdominal endovascular aneurysm repair. Diagn Interv Imaging 2017; 98: 491-497 DOI: 10.1016/j.diii.2017.01.003.
- 18 Pineda DM, Calligaro KD, Tyagi S. et al. Late type II Endoleaks after endovascular aneurysm repair require intervention more frequently than early type II Endoleaks. J Vasc Surg 2018; 67: 449-452 DOI: 10.1016/j.jvs.2017.05.124.
- 19 Powell JT, Sweeting MJ, Ulug P. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg 2017; 104: 166-178 DOI: 10.1002/bjs.10430.
- 20 Solis MM, Ayerdi J, Babcock GA. et al. Mechanism of failure in the treatment of type II Endoleak with percutaneous coil embolization. J Vasc Surg 2002; 36: 485-491 DOI: 10.1067/mva.2002.126542.
- 21 Abularrage CJ, Patel VI, Conrad MF. et al. Improved results using Onyx glue for the treatment of persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg 2012; 56: 630-636 DOI: 10.1016/j.jvs.2012.02.038.
- 22 Horinouchi H, Okada T, Yamaguchi M. et al. Mid-term outcomes and predictors of transarterial embolization for type II Endoleak after endovascular abdominal aortic aneurysm repair. Cardiovasc Intervent Radiol 2020; 43: 696-705 DOI: 10.1007//s00270-020-02436-2.
- 23 Loy LM, Chua JME, Chong TT. et al. Type 2 endoleaks: common and hard to eradicate yet benign?. Cardiovasc Intervent Radiol 2020; 43: 963-970 DOI: 10.1007/s00270-020-02497-3.
- 24 Jamieson RW, Bachoo P, Tambyraja AL. Evidence for ethylene-vinyl-alcohol-copolymer liquid embolic agent as a monotherapy in treatment of Endoleaks. Eur J Vasc Endovasc Surg 2016; 51: 810-814 DOI: 10.1016/j.ejvs.2016.02.015.
- 25 Torikai H, Inoue M, Nakatsuka S. et al. Imaging findings of atypical type II endoleak through vasa vasorum after abdominal endovascular aneurysm repair. Cardiovasc Intervent Radiol 2018; 41: 186-190 DOI: 10.1007/s00270-017-1778-y.
- 26 Mozes GD, Pather K, Oderich GS. et al. Outcomes of Onyx embolization of type II endoleaks after endovascular repair of abdominal aortic aneurysms. Ann Vasc Surg 2020; 67: 223-231 DOI: 10.1016/j.avsg.2020.02.013.
- 27 Müller-Wille R, Wohlgemuth WA, Heiss P. et al. Transarterial embolization of type II endoleaks after EVAR: the role of ethylene vinyl alcohol copolymer (Onyx). Cardiovasc Intervent Radiol 2013; 36: 1288-1295 DOI: 10.1007/s00270-013-0567-5.
- 28 Guimaraes M, Wooster M. Onyx (ethylene-vinyl alcohol copolymer) in peripheral applications. Semin Intervent Radiol 2011; 28: 350-356 DOI: 10.1055/s-0031-1284462.
- 29 Wohlgemuth WA, Uller W, Müller-Wille R. Flüssigembolisate – Onyx als Problemlöser. Radiologe 2013; 53: 223-229 DOI: 10.1007/s00117-012-2421-1.
- 30 Treitl KM, Scherr M, Förth M. et al. Reduction of CT beam hardening artefacts of ethylene vinyl alcohol copolymer by variation of the tantalum content: evaluation in a standardized aortic endoleak phantom. Eur Radiol 2015; 25: 597-605 DOI: 10.1007/s00330-014-3438-9.
- 31 Pitton MB. Diagnosis and management of endoleaks after endovascular aneurysm repair: role of MRI. Abdom Imaging 2006; 31: 339-346 DOI: 10.1007/s00261-005-0370-0.
- 32 Harky A, Zywicka E, Santor G. et al. Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis. J Ultrasound 2019; 22: 65-75 DOI: 10.1007/s40477-019-00364-7.
- 33 Binkert CA, Alencar H, Singh J. et al. Translumbar type II endoleak repair using angiographic CT. J Vasc Intervent Radiol 2006; 17: 1349-1353 DOI: 10.1097/01.RVI.0000231966.74734.7D.
- 34 Wacker FK, Valdeig S, Raatschen HJ. C-arm CT – an adjunct to DSA for endoleak classification in patients with endovascular repair of abdominal aortic aneurysms. Fortschr Röntgenstr 2014; 186: 247-252 DOI: 10.1055/s-0033-1350500.
- 35 Mansueto G, Cenzi D, D'Onofrio M. et al. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: transcaval approach. Cardiovasc Intervent Radiol 2005; 28: 641-645 DOI: 10.1007/s00270-004-0328-6.
- 36 Scali ST, Vlada A, Chang CK. et al. Transcaval embolization as an alternative technique for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2013; 57: 869-874 DOI: 10.1016/j.jvs.2012.09.021.
- 37 Hyatt E, McLaughlin JN, Shah H. et al. Transcaval approach for embolization of type II Endoleak following endovascular aortic aneurysm repair. CVIR Endovasc 2019; 2: 3 DOI: 10.1186/s42155-018-0047-8.
- 38 Ameli-Renani S, Pavlidis V, Mailli L. et al. Transiliac Paraendograft Embolisation of Type 2 Endoleak: An Alternative Approach for Endoleak Management. Cardiovasc Intervent Radiol 2016; 39: 279-283 DOI: 10.1007/s00270-015-1203-3.
- 39 Mewissen MW, Jan MF, Kuten D. et al. Laser-Assisted Transgraft Embolization: A Technique for the Treatment of Type II Endoleaks. J Vasc Interv Radiol 2017; 28: 1600-1603 DOI: 10.1016/j.jvir.2017.07.029.
- 40 Ogawa Y, Hamaguchi S, Nishimaki H. et al. Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR). Cardiovasc Intervent Radiol 2015; 38: 731-735 DOI: 10.1007/s00270-015-1065-8.
- 41 Massis K, Carson 3rd WG, Rozas A. Treatment of type II endoleaks with ethylene-vinyl-alcohol copolymer (Onyx). Vasc Endovascular Surg 2012; 46: 251-257 DOI: 10.1177/1538574412442401.
- 42 Ford CA, Lange BB, Morris CS. Transcatheter embolization of abdominal aortic endograft Endoleaks using onyx and coils: mid-term imaging follow-up. Journal of Vascular Diagnostics and Interventions 2017; 5: 15-19
- 43 Wojtaszek M, Wnuk E, Maciag R. et al. Improving the results of transarterial embolization of type 2 endoleaks with the embolic polymer Onyx. Wideochir Inne Tech Maloinwazyjne 2016; 11: 259-267 DOI: 10.5114/wiitm.2016.64747.
- 44 Aziz A, Menias CO, Sanchez LA. et al. Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion. J Vasc Surg 2012; 55: 1263-1267 DOI: 10.1016/j.jvs2011.10.131.
- 45 Madigan MC, Singh MJ, Chaer RA. et al. Occult type I or III endoleaks are a common cause of failure of type II endoleak treatment after endovascular aortic repair. J Vasc Surg 2019; 69: 432-439 DOI: 10.1016/j.jvs.2018.04.054.
- 46 Guo Q, Zhao J, Ma Y. et al. A meta-analysis of translumbar embolization versus transarterial embolization for type II endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2020; 71: 1029-1034.e1 DOI: 10.1016/j.jvs.2019.05.074.
- 47 Yang RY, Tan KT, Beecroft JR. et al. Direct sac puncture versus transarterial embolization of type II endoleaks: An evaluation and comparison of outcomes. Vascular 2017; 25: 227-233 DOI: 10.1177/1708538116663992.
- 48 Khaja MS, Park AW, Swee W. et al. Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Intervent Radiol 2014; 37: 613-622 DOI: 10.1007/s00270-013-0706-z.
- 49 Sella DM, Frey GT, Giesbrandt K. Osteomyelitis and Discitis Following Translumbar Repair of a Type II Endoleak. Cardiovasc Intervent Radiol 2016; 39: 458-461 DOI: 10.1007/s00270-015-1229-6.
- 50 Das Gupta J, Rana MA, McGrew P. et al. Ischemic lumbosacral plexopathy after extensive Onyx arterial embolization for type 2 endoleak. J Vasc Interv Radiol 2019; 30: 619-621 DOI: 10.1016/j.jvir.2018.09.025.
- 51 Wildgruber M, Müller-Wille R, Busch V. et al. Severe adverse reaction during DMSO injection for Onyx embolization of a thoracic type II endoleak. Cardiovasc Intervent Radiol 2016; 39: 144-145 DOI: 10.1007/s00270-015-1187-z.