Selective Intra-procedural AAA sac Embolization During EVAR Reduces the Rate of Type II Endoleak

Mascoli, Chiara; Freyrie, Antonio; Gargiulo, Mauro; Gallitto, Enrico; Pini, Rodolfo; Faggioli, Gianluca; Serra, Carla; Molo, Chiara De; Stella, Andréa

doi:10.1016/j.ejvs.2015.12.009

Cited by 58 publications

(57 citation statements)

References 26 publications

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“…In 10 (47.6%) patients, considered at high risk of ELII due to the presence of the morphological risk factors cited before [ 16 ], a 45 cm long 5 F Terumo® Destination sheath was introduced over the wire, parallel to the contralateral limb and advanced under fluoroscopy to the AAA-sac. Once the endograft was completely deployed and the aneurysm excluded, Cook MReye coils (MReye Embolization Coil, IMWCE-38-16-45; Cook Medical, Limerick, Ireland),were advanced into the sac through 5 F sheath and intraoperative AAA-sac embolization was performed [ 17 ].…”

Section: Resultsmentioning

confidence: 99%

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The Assessment of Carbon Dioxide Automated Angiography in Type II Endoleaks Detection: Comparison with Contrast-Enhanced Ultrasound

Mascoli

Faggioli

Gallitto

et al. 2018

Contrast Media & Molecular Imaging

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Introduction Iodinated contrast media completion angiography (ICM-A) may underestimate the presence of type II endoleak (ELII) after endovascular aortic repair (EVAR), particularly if they are at low flow. Contrast-enhanced ultrasound (CEUS) has been proposed as the gold standard in ELII detection during EVAR follow-up. Intraprocedural carbon dioxide (CO2) angiography has been shown to be useful in this setting; however no comparative studies including these three techniques are currently available. Our aim was to investigate the accuracy of a new automated CO2 angiographic (CO2-A) system in the detection of ELII, by comparing it with ICM-A and CEUS. Methods A series of consecutive patients undergoing EVAR for abdominal aortic aneurysm (AAA) were enrolled and submitted to ICM-A and CO2-A during the procedure. The iodinated contrast media were delivered through an automatic injector connected to a pigtail catheter in the suprarenal aorta. CO2 was delivered through a recently available automatic injector connected to a 10 F sheath positioned in the external iliac artery. All patients were blindly evaluated by CEUS within postoperative day 1. The ICM-A and CO2-A ability to detect ELII was compared with that of CEUS through Cohen's concordance Index (K). Results Twenty-one patients were enrolled in the study. One (5%), seven (33%), and four (19%) ELII were detected by ICM-A, CO2-A, and CEUS, respectively. The only ELII detected by ICM-A was also detected by CO2-A and CEUS. Three cases of ELII detected by CO2-A were not detected by CEUS. All ELII detected by CEUS were visualized by CO2-A. CEUS and ICM-A showed a poor agreement (Cohen's K: 0.35) while CEUS and CO2-A showed a substantial agreement (Cohen's K: 0.65) for ELII detection. Conclusion CO2-A is safe and effective method for ELII detection in EVAR, with a significantly higher agreement with CEUS if compared with ICM-A. This trial is registered with 155/2015/U/Oss.

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Section: Resultsmentioning

confidence: 99%

“…Patients considered at high risk for persistent type II endoleak (ELII) according to their anatomical characteristics (≥6 efferent patent vessels from AAA-sac, volume of AAA-sac intraluminal thrombosis <40%) [ 16 ] underwent intraoperative AAA-sac embolization as reported in a previous paper [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

The Assessment of Carbon Dioxide Automated Angiography in Type II Endoleaks Detection: Comparison with Contrast-Enhanced Ultrasound

Mascoli

Faggioli

Gallitto

et al. 2018

Contrast Media & Molecular Imaging

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“…11,12,17 Moreover, some reports have suggested that sac embolization during EVAR reduces ELII. 18,19 However, there is currently no strong evidence identifying which patients will benefit the most from preventive branch embolization to avoid ELII. 20 Target and routine embolization of side branches would be unnecessary and time consuming, considering the incidence of ELII and adverse events.…”

Section: Discussionmentioning

confidence: 99%

Identification of Anatomical Risk Factors for Type II Endoleak to Guide Selective Inferior Mesenteric Artery Embolization

Samura

Morikage

Mizoguchi

et al. 2018

Annals of Vascular Surgery

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“…These groups have then looked at pre-emptive coil embolization to prevent T2Es. [2][3][4] Clearly, if we can decrease the need for secondary procedures in EVAR patients, that would be beneficial. The question becomes the cost-benefit ratio.…”

Section: Invited Commentarymentioning

confidence: 99%

Invited commentary

Harris¹

2018

Journal of Vascular Surgery

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Selective Intra-procedural AAA sac Embolization During EVAR Reduces the Rate of Type II Endoleak

Abstract: Selective intra-procedural AAA sac embolization in patients with p-MRF is safe and could be an effective method to reduce ELIIp. Further studies are mandatory to support these results at long-term follow up.

Cited by 58 publications

References 26 publications

The Assessment of Carbon Dioxide Automated Angiography in Type II Endoleaks Detection: Comparison with Contrast-Enhanced Ultrasound

The Assessment of Carbon Dioxide Automated Angiography in Type II Endoleaks Detection: Comparison with Contrast-Enhanced Ultrasound

Identification of Anatomical Risk Factors for Type II Endoleak to Guide Selective Inferior Mesenteric Artery Embolization

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