Purpose. The purpose of this study is to present an alternative technique for management of a type II endoleak associated with aneurysm sac enlargement. Technique. We report the use of a transseptal needle-sheath system for a transcatheter transcaval embolization (TTE) in a 3-staged treatment of a persistent type II endoleak after abdominal EVAR. Inferior vena cava is cannulated through a femoral venous access, and aneurysmal sac access is gained with a puncture through the walls of the 2 vessels at the site where the vein is adjacent to the aneurysm. The whole system (sheath–dilator–needle) is then advanced across the vascular walls into the aortic sac. Thus, embolization with glue is performed. Conclusion. The TTE using a transseptal needle-sheath system demonstrated to be feasible and effective to treat a persistent type II endoleak after failure of 2 attempts of transarterial embolization of the feeding vessels.
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