title: Treatment of types II-IV endoleaks by injecting biocompatible elastomer (PDMS) in the aneurysm sac: an in vitro study.
abstract: OBJECTIVE
  To investigate if an elastomer [polydimethylsiloxane (PDMS)] can be used to effectively treat endoleaks after endovascular aneurysm repair.
  
  
  METHODS
  A latex aneurysm (36-mm inner diameter sac, 15-mm inner diameter neck) was attached to an in vitro circulation model. The aneurysm was excluded from the circulation by placing an unstented polyester graft. Endoleak types II-IV were created using different setups. While the circulation setup running, the aneurysm was filled with contrast medium and then the biocompatible PDMS elastomer was injected to exclude the endoleaks and the perigraft area. The sac was considered full when all contrast was pushed out of the sac and the elastomer flowed into the proximal efferent lumbar artery. Treatment was successful when the aneurysm was free of endoleak after control angiography.
  
  
  RESULTS
  The endoleaks were created successfully in the latex aneurysm models, with contrast present in the sac before "treatment." After elastomer sac filling, all endoleaks were successfully excluded on angiography; there was no leakage of contrast outside the graft lumen in any of the setups. With the type III endoleak, the disruption in the graft material was sealed by the elastomer, while the entire porous graft was encased in elastomer in the type IV endoleak setup. There was no elastomer within the graft lumen in either case.
  
  
  CONCLUSIONS
  This concept of filling the aneurysm sac with PDMS may lead to a percutaneous treatment for endoleaks. While the results of this study show that PDMS may be used to treat endoleaks in vitro, further tests are required to determine if this approach is suitable in vivo.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. W.M.P.F.Bosman@lumc.nl
authors.forename: Willem-Maarten P F
authors.initials: WM
authors.lastname: Bosman
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Hinnen
authors.forename: Tim J
authors.initials: TJ
authors.lastname: van der Steenhoven
authors.forename: Alexander C
authors.initials: AC
authors.lastname: de Vries
authors.forename: Hans L F
authors.initials: HL
authors.lastname: Brom
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: Jaap F
authors.initials: JF
authors.lastname: Hamming
mesh_terms: D000783:Aneurysm / Q000601:surgery*; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D015552:Injections, Intralesional; D007840:Latex; D008955:Models, Cardiovascular; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography
chemical_list: D001672:Biocompatible Materials; D004129:Dimethylpolysiloxanes; D007840:Latex; D011093:Polyethylene Terephthalates