Embolization of Type II Endoleaks Fed by the Inferior Mesenteric Artery: Using the Superior Mesenteric Artery Approach

Abstract

Purpose:

To evaluate the use of a superior mesenteric artery (SMA) approach to embolize type II endoleaks arising from the inferior mesenteric artery (IMA).

Technique:

When reperfusion of the aneurysmal sac via the SMA occurs through the IMA, as shown by computed tomography (CT) and angiography, the IMA origin can be accessed via the marginal artery or the anastomosis of Riolan. The SMA is catheterized with a 5-F catheter, and a coaxial catheter is advanced to the leak to deliver 2- to 8-mm-diameter minicoils to embolize the IMA origin and entire aneurysmal sac. Embolization usually requires from 1 to 2 hours to complete. In our experience with this technique in 11 cases, complications have not occurred, and there has been only one very small residual leak that sealed the next day. Over a 24.5-month follow-up (range 12–39), the endoleaks have remained sealed according to serial color duplex scans.

Conclusions:

Successful percutaneous treatment of type II endoleak due to IMA inflow can be accomplished using an SMA access via the Riolan anastomosis or marginal artery. The procedure appears to be safe and has no adverse effects.

Keywords

abdominal aortic aneurysm endovascular repair stent-graft minicoils

Get full access to this article

View all access options for this article.

References

Malina

Ivancev

Chuter

TAM

. Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion. J Endovasc Surg. 1997;4:23–30.

Heilberger

Schunn

Ritter

. Postoperative color-flow duplex scanning in aortic endografting. J Endovasc Surg. 1997;4:262–271.

White

May

. Three-year experience with the White-Yu Endovascular-GAD Graft for transluminal repair of aortic and iliac aneurysms. J Endovasc Surg. 1997;4:124–136.

White

May

. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg. 1997;4:152–168.

Kato

Semba

Dake

. Embolization of perigraft leaks after endovascular stent-graft treatment of aortic aneurysms. J Vasc Interv Radiol. 1996;7:805–811.

Broeders

IAMJ

Blankensteijn

Gvakharia

. The efficacy of transfemoral endovascular aneurysm management: a study on size changes of the abdominal aorta during mid-term follow-up. Eur J Vasc Endovasc Surg. 1997;14:84–90.

Blum

Voshage

Lammer

. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med. 1997;336:13–20.

Resnikoff

Darling

Chang

. Fate of the excluded abdominal aortic aneurysm sac: long-term follow-up of 831 patients. J Vasc Surg. 1996;24:851–855.

Golzarian

Struyven

Abada

. Endovascular aortic stent-grafts: transcatheter embolization of persistent perigraft leaks. Radiology. 1997;202:731–734.

10.

Marty

Sanchez

Ohki

. Endoleak after endovascular graft repair of experimental aortic aneurysms: does coil embolization with angiographic “seal” lower intra-aneurysmal pressure? J Vasc Surg. 1998;27:454–462.

11.

van Schie

Sieunarine

Holt

. Successful transcatheter embolization of a persistently patent inferior mesenteric artery 1 year after endovascular AAA repair. J Endovasc Surg. 1997;4:312–315.