Treatment of Type II Endoleaks With Ethylene-Vinyl-Alcohol Copolymer (Onyx)

Abstract

We report our single-center experience in treating 101 type II endoleaks with ethylene-vinyl-alcohol copolymer (EVOH, Onyx). In all, 65 endoleaks were embolized transarterially, and 36 were treated through a translumbar approach. Since the first transarterial embolization, when we began attempts to treat all patients initially via common femoral access, 58 (65.9%) of 88 patients were successfully embolized transarterially. All endoleaks in the translumbar group were successfully treated. At a median follow-up length of 15 weeks, a decrease or stabilization in aneurysm size was observed in 39 (73.6%) of the 53 endoleaks that had adequate follow-up computed tomography imaging. The overall residual endoleak rate was 34.0%. There was no difference in efficacy when comparing transarterial and translumbar approaches. We demonstrate that in most cases, transarterial access of the endoleak nidus is feasible, and controlled embolization is possible using EVOH. Furthermore, EVOH appears effective in long-term stabilization of aneurysm size and in preventing residual endoleaks.

Keywords

type II endoleaks ethylene-vinyl-alcohol copolymer EVOH Onyx EVAR AAA

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References

White

May

. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg. 1997;4(2):152–168.

Wain

Marin

Ohki

. Endoleaks after endovascular graft treatment of aortic aneurysms: classification, risk factors, and outcome. J Vasc Surg. 1998;27(1):69–78.

Gelfand

White

Wilson

. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg. 2006;20(1):69–74.

Maldonado

Gagne

. Controversies in the management of type II "branch" endoleaks following endovascular abdominal aortic aneurysm repair. Vasc Endovasc Surg. 2003;37(1):1–12.

Jacobowitz

Rosen

Riles

. The significance and management of the leaking endograft. Semin Vasc Surg. 1999;12(3):199–206.

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(6):1240–1244.

Baum

Carpenter

Tuite

. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms. Radiology. 2000;215:409–413.

Sheehan

Barbato

Compton

. Effectiveness of coiling in the treatment of endoleaks after endovascular repair. J Vasc Surg. 2004;40(3):430–434.

Chutter

Faruqi

Sawhney

. Endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2001;34(1):98–105.

10.

Baum

Cope

Fairman

Carpenter

. Translumbar embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2001;12(1):111–116.

11.

Baum

Carpenter

Golden

. Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques. J Vasc Surg. 2002;35(1):23–29.

12.

van den Berg

Nolthenius

Casparie

. CT-guided thrombin injection into aneurysm sac in a patient with endoleak after endovascular abdominal aortic aneurysm repair. Am J Roentgenol. 2000;175(6):1649–1651.

13.

Rial

Serrano

Vega

. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: translumbar puncture and injection of thrombin into the aneurysm sac. Eur J Vasc Endovasc Surg. 2004;27(3):333–335.

14.

Martin

Dolmatch

Fry

Machan

. Treatment of type II endoleaks with onyx. J Vasc Interv Radiol. 2000;12(5):629–632.

15.

Hinchcliffe

Singh-Ranger

Davidson

. Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg. 2001;22(6):663–665.

16.

Hansen

Kim

Aziz

. Late-onset type II endoleaks and the incidence of secondary intervention. Ann Vasc Surg. 2004;18(1):26–31.

17.

Barbiero

Baratto

Ferro

. Strategies to reduce the rate of type II endoleaks: routine intraoperative embolization of the inferior mesenteric artery and thrombin injection into the aneurysm sac. J Endovasc Ther. 2007:14(5):661–668.