title: Plugging and sealing technique by Onyx to prevent type II endoleak in ruptured abdominal aortic aneurysm.
abstract: Control of back bleeding from the hypogastric artery into the aneurysm after endovascular aneurysm repair (EVAR) of a ruptured aorto-iliac aneurysm may be necessary in order to avoid a type II endoleak. It is an emergency situation and selective catheterization and embolization of the hypogastric artery may be time-consuming and more importantly, it has to be performed before complete exclusion of the aneurysm has been established. We describe a plugging and sealing technique that embolizes the hypogastric artery after the exclusion of a ruptured aorto-iliac aneurysm using the embolizing agent Onyx. The mortality rate of the 16 patients treated in our institute with this technique was 25% (4/16) at 30-day and 31% (5/16) at 90-day follow up. One patient had a type II endoleak at one-year follow-up. The EVAR procedure can focus completely on controlling the acute life-threatening situation, with the embolization performed at the end of the procedure.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Sweden. Thomas.larzon@orcbroll.se
authors.forename: Thomas
authors.initials: T
authors.lastname: Larzon
authors.forename: Tal
authors.initials: T
authors.lastname: Hörer
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057867:Endoleak / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010388:Pelvis / Q000098:blood supply*; D011145:Polyvinyls / Q000009:adverse effects / Q000627:therapeutic use*; D011859:Radiography; D013635:Tantalum / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum