Combined laparoscopic and percutaneous treatment of a type II endoleak following endovascular abdominal aortic aneurysm repair.
We describe a novel approach in treating a persistent type II endoleak related to the inferior mesenteric artery (IMA) and the lower lumbar arteries. The endoleak failed to thrombose following percutaneous IMA coil embolization. We proceeded to one-stage laparoscopic IMA division and intra-sac thrombin injection under direct laparoscopic vision and fluroscopy. A CT scan at 1 and 7 months post-intervention showed no evidence of endoleak and the growth of the aneurysm was arrested. This combined laparoscopic and percutaneous approach may be a useful treatment option in the management of persistent complex type II endoleak. Its durability, however has yet to be defined.
Karkos
Christos D
CD
Department of Vascular & Endovascular Surgery, Leicester Royal Infirmary, Leicester, LE1 5WW, UK. ckarkos@hotmail.com
Hayes
Paul D
PD
Lloyd
David M
DM
Fishwick
Guy
G
White
Steve A
SA
Quadar
Salman
S
Sayers
Robert D
RD
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D005471:Fluoroscopy; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007269:Injections, Intra-Arterial; D010535:Laparoscopy; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D013917:Thrombin / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D006490:Hemostatics; D013917:Thrombin