Type II Endoleak: Transperitoneal Sacotomy and Ligation of Side Branch Endoleaks Responsible for Aneurysm Sac Expansion

Abstract

Purpose:

To demonstrate aneurysm sac expansion in the face of a type II endoleak and its treatment with open ligation of multiple side branch endoleaks.

Case Report:

An 81-year-old patient had undergone elective endovascular repair of a 6.3-cm infrarenal abdominal aortic aneurysm in September 1999. Routine spiral computed tomographic angiography at 10 months disclosed a type II endoleak; the aneurysm sac diameter had grown to 7.4 cm. Selective angiography revealed multiple lumbar endoleaks and a patent inferior mesenteric artery. Laparotomy and sacotomy was performed, confirming the presence of pulsatile type II endoleaks, which were ligated successfully. The patient made a full postoperative recovery.

Conclusions:

Type II endoleaks may cause aneurysm expansion. Open repair of multiple type II endoleaks is feasible and may be useful where endovascular or laparoscopic techniques are at high risk of procedural failure, such as multiple endoleak channels.

Keywords

Zenith stent-graft inferior mesenteric artery lumbar artery intrasac pressure endotension

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References

Kato

Semba

Dake

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

Laheij

Buth

Harris

. Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR). Br J Surg. 2000;87:1666–1673.

Arko

Rubin

Johnson

. Type-II endoleaks following endovascular AAA repair: preoperative predictors and long-term effects. J Endovasc Ther. 2001;8:503–510.

White

Donayre

Walot

. Abdominal aortic aneurysm rupture following endoluminal graft deployment: report of a predictable event. J Endovasc Ther. 2000;7:257–262.

Hinchliffe

Singh-Ranger

Davidson

. Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg. 2001;22:563–565.

Wisselink

Cuesta

Berends

. Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair. J Vasc Surg. 2000;31:1240–1244.

Edoga

. Laparoscopic salvage surgery following failed endovascular abdominal aortic aneurysm repair. Paper presented at: New Technologies in Vascular Surgery; June 27, 2001; Rome, Italy.

Chuter

TAM

Ivancev

Malina

. Aneurysm pressure following endovascular exclusion. Eur J Vasc Endovasc Surg. 1997;13:85–87.

Treharne

Loftus

Thompson

. Quality control during endovascular aneurysm repair: monitoring of aneurysm sac pressure and superficial femoral artery flow velocity. J Endovasc Surg. 1999;6:239–245.

10.

Baum

Carpenter

Cope

. Aneurysm sac measurements after endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2001;33:32–41.

11.

Schurink

GWH

Aarts

NJM

van Baalen

. Experimental study of the influence of endoleak size on pressure in the aneurysmal sac and the consequences of thrombosis. Br J Surg. 2000;87:71–78.

12.

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.

13.

Görich

Rilinger

Sokiranski

. Embolization of type II endoleaks fed by the inferior mesenteric artery: using the superior mesenteric artery approach. J Endovasc Ther. 2000;7:297–301.