Successful Celiac Trunk Robotic Ligature to Treat a Type II Endoleak After Thoracoabdominal Aneurysm Endovascular Exclusion

Abstract

Type II endoleak represents the most frequent complication after endovascular abdominal aortic aneurysm repair. Usually it is followed up and treated only in cases of aneurysmal sac enlargement >10 mm respect to the beginning. The incidence of this type of endoleak after para-renal and thoraco-abdominal aortic aneurysm (TAAA) aneurysms endovascular exclusion is underinvestigated. Modalities of treatment are well described in the current guidelines. Our patient had a type II endoleak from the celiac trunk after TAA aneurysm exclusion with a custom made T-branch endograft: he was judged at high risk for open repair; endovascular options were excluded for anatomical criteria, so based on the experience of the general surgeon of our hospital we opted for the robotic ligature of the celiac trunk, excluding visceral ischemia with intraoperative injection of green indocyanine, obtaining a very excellent result. In the current literature is reported some case of inferior mesenteric artery or lumbar arteries robotic ligature but celiac trunk robotic ligature to treat type II endoleak has never been reported to date.

Clinical Impact

Type II endoleaks after endovascular exclusion of TAAA are underinvestigated, especially for those from the celiac trunk, and there are different modalities of treatment. For complex TAAA in patients already submitted to multiple endovascular procedures, the Robotic ligation of the Celiac Trunk to exclude the endoleak represents an innovative and less invasive multidisciplinary approach that can offer a valid alternative with success. In addition the technique used in our center and described in our case has been not yet described in the current literature and represents a very important innovation.