Fibrin glue aneurysm sac embolization at the time of endografting.
OBJECTIVE
To describe the procedural details for primary prevention of type II endoleak with fibrin glue injection into the aneurysm sac at the time of endografting.


METHODS
After deployment of the main stent-graft component, the angiographic pigtail catheter is withdrawn, leaving the 0.035-inch standard guidewire between the endograft and the native aorta. Through a brachial-femoral arterial guidewire loop, an 11-cm-long, 6-F introducer is advanced over the wire into the contralateral iliac artery. After deployment of the contralateral iliac extension, a 23-cm, 5-F sheath is advanced over the wire into the aneurysm sac. The wire and vessel dilator are removed, leaving the cannula in the sac. To prevent distal embolization of the sealant, a balloon is inflated in the contralateral limb to secure it to the native vessel before 5 mL of fibrin sealant are injected into the sac via a double-syringe delivery system inserted through the sheath. The balloon is left in place for 1 minute after sealant injection. In 64 consecutive patients in whom this technique has been used, sac embolization has been successful. There have been no intraoperative complications or in-hospital mortality. Over a mean follow-up of 9.3+/-4.4 months (range 1-18), only 1 lumbar endoleak has been detected on surveillance imaging.


CONCLUSIONS
This preventive strategy appears to be an effective approach and the best therapeutic choice for preventive management of type II endoleak.
Zanchetta
Mario
M
Department of Cardiovascular Disease, Cittadella, Padua, Italy. emodinacit@ulss15.pd.it
Faresin
Francesca
F
Pedon
Luigi
L
Riggi
Melania
M
Ronsivalle
Salvatore
S
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D004621:Embolization, Therapeutic; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D015607:Stents; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives