Surgical Experience of Persistent Type 2 Endoleaks with Aneurysmal Sac Enlargement after Endovascular Aneurysm Repair

Abstract

Herein, we present a case of a successful treatment of persistent type 2 endoleaks associated with aneurysmal sac enlargement after endovascular aneurysm repair in an elderly patient. We confirmed the diagnosis by abdominal computed tomography and selective angiography revealing an 11.0-cm aneurysm sac with type 2 endoleaks. An attempt for the endovascular embolization of collateral arteries was unsuccessful due to anatomic variations and their multiple complex communications. Instead, transperitoneal sacotomy and direct suturing on the feeding target vessels was successfully performed without any endograft damage. In conclusion, sacotomy appears to be a feasible therapeutic substitute where endovascular or other techniques have a high risk of failure and lead to unsuccessful results.

Partial open conversion with proximal aortic banding and endograft preservation is a safe option for the treatment of persistent type II endoleaks

“…Endovascular aneurysm repair (EVAR) is a common, less invasive treatment for abdominal aortic aneurysms (AAA). 1,2 Incidence of EVAR-related complications is unfortunately increasing. 1 The most common complication is endoleak, with an incidence as high as 30.5% after EVAR.…”

“…3 Type II endoleaks, defined as persistent filling of the AAA sac by patent branch arteries, comprise up to 76% of reported endoleaks and are thought to occur between 6-30% of all EVAR patients. [1][2][4][5][6] Historic data on open aortic bypass and popliteal artery aneurysm repair by sac exclusion describe similar mechanisms of persistent sac perfusion via collaterals in a small proportion of patients. [7][8][9] Type II endoleaks require lifelong surveillance but the urgency of treatment and preferred method are debated.…”

“…4,10 Other studies describe persistent type II endoleaks, which remained unresolved for six months or longer and resulted in sac expansion. 2,5,6,11,12 Hinchliffe et al 13 was the first to report a successful sacotomy with ligation of back-feeding vessels, an open partial conversion (OPC) procedure, to treat a persistent type II endoleak while preserving the endograft in 2002. Since then, several other authors have demonstrated similar results using the OPC technique.…”