title: Laparoscopic Transarterial Embolization of Type II Endoleak after Branched/Fenestrated Thoracoabdominal Aortic Aneurysm Endovascular Repair.
abstract: Type II endoleak is the most frequent procedure-related complication during endovascular aneurysm exclusion. Actually, there is little controversy in the management of type I and III endoleak, while type II endoleak still generates conflicting reports about their timing and type of treatment. Currently, the intervention is needed only in case of sac enlargement but not in case of persistent endoleak alone. We report the case of a 77-year-old man treated with a custom-made branched/fenestrated endograft for a type III thoracoabdominal aortic aneurysm. A low-flow type II endoleak was detected at the end of the intervention, and a conservative approach was adopted. The sixth month follow-up computed tomography scan demonstrated a 6-mm aneurysm sac growth that required the type II endoleak management. The endoleak nidus, situated between the inferior mesenteric artery (IMA) and left renal artery stent graft, was embolized through the IMA punctured laparoscopically. IMA origin laparoscopic clipping completed the intervention. To our knowledge, this is a unique case in the literature. Type II endoleak management should be reserved to selected patients. The combination of different techniques may offer safe and feasible treatment options in complex aneurysms treated with advanced endovascular materials.
authors.affiliation: Department of Surgery, Vascular Surgery Unit, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Fadda
authors.affiliation: Department of Surgery, Vascular Surgery Unit, "San Francesco" Hospital, Nuoro, Italy; Department "Paride Stefanini", Vascular Surgery Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. Electronic address: kasemiholta@libero.it.
authors.forename: Holta
authors.initials: H
authors.lastname: Kasemi
authors.affiliation: Department of Surgery, Vascular Surgery Unit, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Costantino Luca
authors.initials: CL
authors.lastname: Di Angelo
authors.affiliation: Department of Surgery, Surgery Unit, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Nisco
authors.affiliation: Department of Surgery, Surgery Unit, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Balestra
authors.affiliation: Department of Surgery, Surgery Unit, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cruccu
authors.affiliation: Department of Surgery, Vascular Surgery Unit, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Marino
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome