Type II endoleak prevention with coil embolization during endovascular aneurysm repair in high-risk patients.
OBJECTIVE
This study evaluated endoleak level and size decrease of infrarenal abdominal aortic aneurysm (AAA) after endovascular aneurysm repair (EVAR) with coil embolization in patients at high risk for type II endoleak.


METHODS
Between 2009 and 2013, 83 of 187 patients (44.3%) who underwent EVAR for AAA also underwent coil embolization of the aneurysm sac immediately after complete stent graft release because of risk factors for type II endoleak, including absence of a circumferential thrombus, two or more pairs of patent lumbar arteries, or a patent inferior mesenteric artery. Coil embolization was achieved using a 4F catheter with a microcatheter placed between the stent graft and the aneurysm wall. Computed tomography and color duplex ultrasound imaging were performed 1, 6, 12, and 24 months later to look for an endoleak and assess aneurysm sac diameter.


RESULTS
Mean follow-up was 24 ± 11 months (range, 6-53 months). A mean of 12 coils (range, 4-23) was used. Technical success was achieved in all patients, with no procedurally related complications. Follow-up computed tomography showed type II endoleak in one patient. Aneurysm sac diameter was significantly decreased after 6 months (P = .001), 12 months (P = .001), and 24 months (P = .001). Surgery was required in one patient for common femoral artery occlusion unrelated to the procedure and in another patient for distal type I endoleak.


CONCLUSIONS
Aneurysm sac coil embolization during EVAR for patients at risk for type II endoleak is technically feasible, safe, and effective in preventing type II endoleak. This procedure leads to rapid AAA shrinkage. Thus, coil embolization could be used routinely to improve EVAR outcomes for patients at risk for type II endoleak.
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Le Plessis Robinson, France. Electronic address: d.fabre@ccml.fr.
Dominique
D
Fabre
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Le Plessis Robinson, France.
Elie
E
Fadel
Department of Radiology, Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Le Plessis Robinson, France.
Philippe
P
Brenot
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Le Plessis Robinson, France.
Sarah
S
Hamdi
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Le Plessis Robinson, France.
Abel
A
Gomez Caro
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Le Plessis Robinson, France.
Sacha
S
Mussot
Department of Vascular Surgery, Henri Mondor Hospital, Creteil, Val de Marne University, Creteil, France.
Jean-Pierre
JP
Becquemin
Department of Radiology, Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Le Plessis Robinson, France.
Claude
C
Angel
D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D057510:Endovascular Procedures / Q000009:adverse effects*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D062666:Vascular Access Devices