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Semin intervent Radiol 2021; 38(05): 576-580
DOI: 10.1055/s-0041-1736656
How I Do It

How I Do It: Computed Tomography–Guided Modified Translumbar Embolization of Type 2 Endoleak

Charles T. Burke
1   Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
,
Hyeon Yu
1   Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Endovascular aortic aneurysm repair (EVAR) is a standard and less invasive treatment modality widely performed for abdominal aortic aneurysms (AAAs) with early survival benefits and lower morbidity and mortality rates than open repair.[1] However, EVAR requires continuous surveillance for the detection of endoleaks and aneurysm sac expansion. Endoleak is defined as a persistent flow into the aneurysm sac due to incomplete exclusion of the aneurysm. Type 2 endoleak is the most common complication after EVAR, occurring in 10 to 45% of patients with AAA and approximately half of all endoleaks.[2] [3] Currently, the optimal approach to the treatment of type 2 endoleak remains controversial, and there is no consensus as to appropriate indications for type 2 endoleak repair.[2] [4] [5] [6] Several meta-analyses report that most type 2 endoleaks maintain a benign course and do not require any treatment.[5] [6] They eventually thrombose spontaneously within the first 6 months after EVAR. However, in patients who continue to have aneurysm sac growth, defined as greater than 5 mm over 6 months, there is an increased risk of aneurysm rupture; thus, endoleak embolization is generally recognized as appropriate in this setting.[5] [6]

Treatment options for type 2 endoleak include transarterial, translumbar, and transcaval embolization. In addition, preoperative embolization of the aortic side branches or intraoperative occlusion of the aneurysm sac is also considered a preemptive management option. Currently, the most commonly used interventional techniques are transarterial and translumbar embolization. The translumbar approach typically involves percutaneous access to the aneurysm sac under computed tomography (CT), followed by embolization of the endoleak under fluoroscopy in a standard angiography suite. However, a modified translumbar technique, a CT-guided direct percutaneous access to the aneurysm sac with embolization of the endoleak, has not been reported. This article describes the technical details and rationale of the CT-guided direct translumbar puncture with simultaneous embolization of endoleaks. Also, currently available management options and their outcomes for type 2 endoleaks are discussed with the review of the literature.



Publication History

Article published online:
24 November 2021

© 2021. Thieme. All rights reserved.

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