title: Double coaxial microcatheter technique for transarterial aneurysm sac embolization of type II endoleaks after endovascular abdominal aortic repair.
abstract: OBJECTIVE
  To evaluate the feasibility and efficacy of transarterial sac embolization with a mixture of N-butyl cyanoacrylate and ethiodized oil (Lipiodol; Guerbet Japan, Tokyo, Japan) (NBCA-LPD) for type II endoleaks after endovascular aortic repair (EVAR) using a double coaxial microcatheter technique.
  
  
  METHODS
  A retrospective review was performed of 20 consecutive cases of type II endoleaks treated by transarterial embolization using the technique from August 2010 to June 2013. The treatment indication was persistent type II endoleak over 6 months after EVAR associated with aneurysm expansion ≥ 5 mm in maximum diameter. A 1.9-F nontapered microcatheter was advanced to the aneurysmal sac through a 2.7-F microcatheter, which was coaxially introduced through a catheter. The endpoint of the procedure was intrasaccular filling with NBCA-LPD and occlusion of the feeder of the type II endoleak. The technical success rate was defined as success in transarterial intrasaccular approach followed by embolization of the intrasaccular channel and inflow arteries. Clinical success was defined as aneurysmal sac shrinkage or stabilization (freedom from sac expansion > 5 mm in maximum diameter).
  
  
  RESULTS
  Technical success was achieved in 18 of 20 cases. During a mean follow-up period of 18.5 months, complete sac occlusion was observed in 13 cases (65%). Clinical success was achieved in 16 cases (80%). No serious complications were observed.
  
  
  CONCLUSIONS
  The transarterial intrasaccular approach with a double coaxial microcatheter technique can be successfully performed in most cases, and transarterial aneurysm sac embolization using NBCA-LPD has been proven to be feasible.
authors.affiliation: Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593. Electronic address: hongou@oita-u.ac.jp.
authors.forename: Norio
authors.initials: N
authors.lastname: Hongo
authors.affiliation: Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593.
authors.forename: Hiro
authors.initials: H
authors.lastname: Kiyosue
authors.affiliation: Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593.
authors.forename: Rieko
authors.initials: R
authors.lastname: Shuto
authors.affiliation: Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Kamei
authors.affiliation: Department of Cardiovascular Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593.
authors.forename: Shinji
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tanoue
authors.affiliation: Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama, Yufu, Oita, Japan 879-5593.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Mori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D057867:Endoleak / Q000209:etiology* / Q000628:therapy*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics