Delayed rupture after endovascular aortic aneurysm repair (EVAR) secondary to an isolated type II endoleak is rare. A woman in her 90s developed an abdominal aortic aneurysm rupture 20 months following EVAR. A type II endoleak was revealed via digital subtraction angiography. The trans-stent graft approach using a Brockenbrough needle was immediately performed, and the endoleak cavity was occluded with nbutyl-2-cyanoacrylate. Trans-stent graft embolization can be adopted promptly following angiography without changing the body position or access site, even in cases of delayed rupture due to isolated type II endoleak.

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The purpose of this report was to describe the reorientation of the chimney graft technique to downsize brachial artery access during thoracic endovascular aortic repair and thus preserve left subclavian artery flow. In the case described herein, the chimney graft was advanced not from the brachial or axillary artery, but from the common femoral artery, over a brachiofemoral pull-through wire. The chimney graft was then turned out into the ascending aorta by balloon dilatation via percutaneous brachial access (reorientation). Despite the use of a large-diameter chimney graft, the chimney technique with percutaneous brachial access was successfully performed using the reorientation technique.

Purpose: To report our initial experience with transarterial infusion chemotherapy/embolization (TAI/TAE) in the pelvic cavity using a steerable microcatheter alone through the outer cannula of an 18-gauge needle used as a sheath (SMOC) without a conventional diagnostic catheter and introducer sheath.Materials and Methods: From January to September 2017, the SMOC method was attempted in six consecutive patients (4 male, 2 female; median age, 79.5 years; range, 21-88 years) undergoing elective TAI/TAE in the pelvic cavity. TAI was performed with cisplatin and methotrexate for bladder cancer in four patients, while TAE was performed with gelatin sponge particles for chronic urethral bleeding after total cystectomy in one patient and for a retained placenta in one patient. The items evaluated were the performance of TAI/TAE procedure with the SMOC method, fluoroscopic time, manual compression time, post-procedural bed rest time, and complications.Results: Five of six patients (83%) successfully underwent the procedure with the SMOC method; in one patient with a severely tortuous iliac artery, we abandoned the SMOC method. The median fluoroscopic time in the five successful cases was 16 min (range, 7-33 min). The manual compression time was approximately 5 min in each case. The postoperative bed rest time was 5 h in the first three cases and 2 h in the subsequent two cases. No procedure-related complications, including arterial injury and hematoma formation, occurred in any patients.Conclusions: The SMOC method can be an alternative to the conventional method for TAI/TAE in the pelvic cavity.