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Home > Vascular Annual Meeting > saltzberg_safety_efficacy

Safety and Efficacy of Coil Embolization for Type 2 Endoleaks: A Single Center Experience

Stephanie Saltzberg, Manish Mehta, Yaron Sternbach, John B. Taggert, Kathleen J. Ozsvath, Sean P. Roddy, Paul B. Kreienberg, Philip S. K. Paty, Benjamin B. Chang, Dhiraj M. Shah, R. C. Darling, III.
Albany Medical College, Albany, N.Y.
 
OBJECTIVES(s): Recent data suggests that Type 2 endoleaks after endovascular aneurysm repair (EVAR) transmit systemic pressures to the abdominal aortic aneurysm (AAA) and are associated with an increased incidence of adverse outcomes, including aneurysm rupture. We reviewed our experience with percutaneous coil embolization for Type 2 endoleaks.

METHODS: In 2002, we established a protocol for treatment of Type 2 endoleaks after EVAR which included translumbar percutaneous aneurysm sac puncture and coil embolization. All patients with AAA >5 cm that did not decrease in size with Type 2 endoleak greater than 6 months post EVAR, and all patients with increasing AAA sacs with Type 2 endoleaks were included. All embolizations were performed via a percutaneous translumbar puncture using a 6 Fr sheath and coils only. Coils were delivered by selective branch catheterization when feasible. Patients were followed by sequential 6 month CT scans. Data was prospectively collected in a vascular registry. Study endpoints included perioperative morbidity and mortality, reintervention rate, and mid-term follow-up.

RESULTS: Since 2002, 1431 patients have undergone EVAR using a variety of stent grafts. A total of 76 coil embolizations (5.3%) were performed in 71 patients for treatment of Type 2 endoleaks. 82% (n=58) of patients were male, with a mean age of 76 years, and a mean preoperative maximal aneurysm size of 5.9 cm (range 4.0-9.0 cm). Initial technical success rate was 100%. Two patients required concomitant stent graft extension. Twelve patients (15.8%) required subsequent intervention: 4 stent graft extensions, 2 new stent grafts, 1 ligation of the IMA, and 5 repeat coil embolizations. There were no cases of retroperitoneal bleeding requiring prolonged hospitalization or blood transfusions. The mean follow-up was 28 months. There were 2 complications: one (1.3%) patient developed aortoenteric fistula and ultimately died, and 1 (1.3%) patient had ischemic colitis requiring sigmoid colon resection. There were no explants or aneurysm ruptures.

CONCLUSIONS: Translumbar percutaneous coil embolization for Type 2 endoleaks might be required in up to 5% of patients following EVAR, and can be performed with minimal morbidity and mortality. The complications are unpredictable, and care should be exercised in avoiding bowel injury.

AUTHOR DISCLOSURES: S. Saltzberg, None; M. Mehta, None; Y. Sternbach, None; J.B. Taggert, None; K.J. Ozsvath, None; S.P. Roddy, None; P.B. Kreienberg, None; P.S.K. Paty, None; B.B. Chang, None; D.M. Shah, None; R.C. Darling, None.