Impact of System-F in Delivering Vascular Plugs for Aortic Side Branch Embolization During Endovascular Aneurysm Repair

Abstract

Purpose:

This study aimed to illustrate the utility of our original system to deliver vascular plugs into aortic side branches during endovascular aneurysm repair (EVAR).

Technique:

Our device, which we named “System-F,” consists of a 14 Fr sheath, a 12 Fr long sheath with a side hole, a stiff guidewire as a shaft, and a parallelly-inserted delivery catheter navigated through the side hole into the aneurysm sac. Vertical motion and horizontal rotation of the side hole allow multidimensional movement of the delivery catheter within the aneurysm. This system was applied in 7 cases undergoing EVAR; 4 inferior mesenteric arteries and 14 lumbar arteries were embolized using vascular plugs. Type II endoleak (T2EL) was not observed in the follow-up survey of any case. Conclusion: The applicability of System-F for vascular plug placement in the side branches of abdominal aortic aneurysms has the potential to achieve high delivery capability and be widely applied for the prevention of T2EL.

Clinical Impact

System-F has potential to change the strategies of pre-EVAR embolization.

Keywords

endovascular aneurysm repair side-branch embolization prophylactic embolization preemptive embolization vascular plug

Get full access to this article

View all access options for this article.

References

Parry

Kessel

Robertson

, et al. Type II endoleaks: predictable, preventable, and sometimes treatable? J Vasc Surg. 2002;36(1):105–110. doi:10.1067/mva.2002.125023.

Aoki

Maruta

Omoto

, et al. Midterm outcomes of endovascular abdominal aortic aneurysm repair with prevention of type 2 endoleak by intraoperative aortic side branch coil embolization. Ann Vasc Surg. 2022;78:180–189. doi:10.1016/j.avsg.2021.06.037.

Branzan

Geisler

Steiner

, et al. Type II endoleak and aortic aneurysm sac shrinkage after preemptive embolization of aneurysm sac side branches. J Vasc Surg. 2021;73(6):1973–1979. doi:10.1016/j.jvs.2020.11.032.

Samura

Morikage

Otsuka

, et al. Endovascular aneurysm repair with inferior mesenteric artery embolization for preventing type II endoleak: a prospective randomized controlled trial. Ann Surg. 2020;271(2):238–244. doi:10.1097/SLA.0000000000003299.

Samura

Morikage

Mizoguchi

, et al. Effectiveness of embolization of inferior mesenteric artery to prevent type II endoleak following endovascular aneurysm repair: a review of the literature. Ann Vasc Dis. 2018;11(3):259–264. doi:10.3400/avd.ra.18-00064.

Lopera

JE.

The Amplatzer vascular plug: review of evolution and current applications. Semin Intervent Radiol. 2015;32(4):356–369. doi:10.1055/s-0035-1564810.

Burbelko

Kalinowski

Heverhagen

, et al. Prevention of type II endoleak using the AMPLATZER vascular plug before endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2014;47(1):28–36. doi:10.1016/j.ejvs.2013.10.003.

Müller-Wille

Uller

Gössmann

, et al. Inferior mesenteric artery embolization before endovascular aortic aneurysm repair using Amplatzer vascular plug type 4. Cardiovasc Intervent Radiol. 2014;37(4):928–934. doi:10.1007/s00270-013-0762-4.

Morikage

Samura

Takeuchi

, et al. Innovative procedure for inferior mesenteric artery embolization using the Amplatzer vascular plug 4 during endovascular aneurysm repair. Ann Vasc Surg. 2017;44:431–438. doi:10.1016/j.avsg.2017.03.181.

10.

Zablah

Fry

Eilers

, et al. The length versus diameter relationship and radial force properties of the Amplatzer™ vascular plug type IV: observations for oversizing. Cardiovasc Eng Technol. 2019;10(2):271–276. doi:10.1007/s13239-019-00409-2.

11.

Mallios

Yankovic

Boura

, et al. Three new techniques for creation of a steerable sheath, a 4F snare, and bidirectional sheath inversion using existing endovascular materials. J Vasc Surg. 2012;56(3):853–860.

12.

Panuccio

Rohlffs

Makaloski

, et al. Through-and-through suture technique to stabilize a sheath in branched endovascular aortic repair. J Endovasc Ther. 2019;26(6):805–809.