title: Totally Percutaneous Aneurysm Sac Embolization During Endovascular Aneurysm Repair.
abstract: To describe a sac embolization technique modification for type II endoleak prevention that makes a totally percutaneous approach feasible during endovascular aneurysm repair (EVAR) using the Excluder stent-graft.
  
  
  
  Percutaneous access of the common femoral arteries is obtained and 2 suture-mediated closure systems are placed on each side. A 16-F or 18-F sheath is placed for delivery of the Excluder stent-graft main body and a 16-F sheath is used on the contralateral side. After the stent-graft and contralateral limb component are delivered to their intended positions, a standard 0.035-inch hydrophilic guidewire is placed into the aneurysm sac through the same 16-F sheath. Then a 5-F, straight, 65-cm-long catheter is advanced over the standard wire into the sac in parallel with the contralateral limb. The contralateral limb is deployed, the standard guidewire is removed; coils are released through the 5-F catheter into the sac, followed by injection of 5 to 10 mL of double-component fibrin glue.
  
  
  
  Totally percutaneous, nonselective sac embolization during EVAR, with a single access on each femoral artery, is feasible and helpful to physicians who wish to perform intraoperative sac embolization without relevant changes in their usual EVAR procedure.
authors.affiliation: 1 Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, ULSS 8 Asolo, Ospedale San Giacomo Apostolo, Castelfranco Veneto, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ferretto
authors.affiliation: 1 Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, ULSS 8 Asolo, Ospedale San Giacomo Apostolo, Castelfranco Veneto, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Irsara
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome; D062666:Vascular Access Devices
keywords: abdominal aortic aneurysm; aneurysm sac embolization; endovascular aneurysm repair; intrasac embolization; percutaneous embolization; type II endoleak