Ann Surg Treat Res.  2015 Apr;88(4):232-235. 10.4174/astr.2015.88.4.232.

Experience of direct percutaneous sac injection in type II endoleak using cone beam computed tomography

• Park YS
• Do YS
• Park HS
• Park KB
• Kim DI

• KMID: 2167025
• DOI: http://doi.org/10.4174/astr.2015.88.4.232

Abstract

Cone beam CT, usually used in dental area, could easily obtain 3-dimensional images using cone beam shaped ionized radiation. Cone beam CT is very useful for direct percutaneous sac injection (DPSI) which needs very precise measurement to avoid puncture of inferior vena cava or vessel around sac or stent graft. Here we describe two cases of DPSI using cone beam CT. In case 1, a 79-year-old male had widening of preexisted type II endoleak after endovascular aneurysm repair (EVAR). However, transarterial embolization failed due to tortuous collateral branches of lumbar arteries. In case 2, a 72-year-old female had symptomatic sac enlargement by type II endoleak after EVAR. However, there was no route to approach the lumbar arteries. Therefore, we performed DPSI assisted by cone beam CT in cases 1, 2. Six-month CT follow-up revealed no sign of sac enlargement by type II endoleak.

Keyword

Cone beam computed tomography; Endovascular procedures; Endoleak; Therapeutic embolization

MeSH Terms

Aged
Aneurysm
Arteries
Blood Vessel Prosthesis
Cone-Beam Computed Tomography*
Embolization, Therapeutic
Endoleak*
Endovascular Procedures
Female
Follow-Up Studies
Humans
Male
Punctures
Vena Cava, Inferior

Figure

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  Fig. 1 (A) Type II endoleak. (B) Transarterial approach was failed due to tortuous collateral branches of both lumbar arteries. The tip of a microcatheter in a collateral branch from the internal iliac artery (white arrows), the lumbar artery reconstituted from a collateral branch from the internal iliac artery (white arrow heads). (C) Direction of direct percutaneous sac injection. The patient was placed in prone position. 21-gauge Chiba needle was inserted through paraspinal route directly into type II endoleak sac under fluoroscopy guidance.

• 

  Fig. 2 (A) Type II endoleak. (B) Transarterial approach was failed due to tortuous collateral branches of lumbar arteries. A tortuous collateral artery from the internal iliac artery (white arrow). (C) Direction of direct percutaneous sac injection using cone beam CT. (D) Two milliliters of glue mixed in 4 mL of Lipidol was injected into the type II endoleak sac under fluoroscopy guidance.

Reference

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