Intraoperative sac embolizaion with coils and fibrin glue during endovascular aneurysm repair for preventing postoperative type <b>Ⅱ</b> endoleak_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Tiehao ¹ , WANG Jiarong ¹ , ZHAO Jichun ¹ , HUANG Bin ¹ , WENG Chengxin ¹ ,  ZHANG Hua ² ,  YUAN Ding ¹

1. Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

ZHANG Hua, Email: huazh0108@126.com; YUAN Ding, Email: docyuanding@gmail.com

Keywords：

endovascular aneurysm repair; type Ⅱ endoleak; sac filling; coil; fibrin glue

DOI：

10.7507/1007-9424.202209016

Video：

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Objective To investigate the technical feasibility and effectiveness of intraoperative sac embolizaion with coils and fibrin glue for preventing type Ⅱ endoleak after endovascular aneurysm repair (EVAR). Methods A patient with abdominal aortic aneurysm (AAA), which had high risk of type Ⅱ endoleaks, was treated with combined packing of coils and fibrin glue in order to prevent type Ⅱ endoleak after EVAR. Percutaneous catheter preset and balloon occlusion were used to ensure accurate packing. Results At the end of the operation, the angiography showed that the blood flow of the stent and distal artery was unobstructed, there was no type Ⅰ and Ⅲ endoleaks, and delayed angiogram showed no collateral circulation of aneurysm. The procedure was successful. The operative duration was 120 min and the blood loss was only 20 mL. No complications such as colonic ischemia and ectopic embolism occurred, and the patient was discharged on 3 days after operation. At 6 months after follow-up, the computerized topographic angiography showed that the aneurysm cavity was completely thrombotic, without type II endoleak, and the diameter and volume of aneurysm were reduced. Conclusions The technique of intraoperative sac embolizaion with coils and fibrin glue during EVAR is safe and effective to prevent postoperative endoleaks, which is simple and feasibility. Intraoperative indwelling catheter and balloon blocking are the key points of successful implementation of this technique.

Citation： WANG Tiehao, WANG Jiarong, ZHAO Jichun, HUANG Bin, WENG Chengxin, ZHANG Hua, YUAN Ding. Intraoperative sac embolizaion with coils and fibrin glue during endovascular aneurysm repair for preventing postoperative type Ⅱ endoleak. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(12): 1562-1567. doi: 10.7507/1007-9424.202209016 Copy

1.	Lederle FA, Kyriakides TC, Stroupe KT, et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med, 2019, 380(22): 2126-2135.
2.	Schanzer A, Oderich GS. Management of abdominal aortic aneurysms. N Engl J Med, 2021, 385(18): 1690-1698.
3.	Seike Y, Matsuda H, Shimizu H, et al. Nationwide analysis of persistent type Ⅱ endoleak and late outcomes of endovascular abdominal aortic aneurysm repair in Japan: A Propensity-Matched Analysis. Circulation, 2022, 145(14): 1056-1066. doi: 10.1161/CIRCULATIONAHA.121.056581.
4.	Ultee KHJ, Büttner S, Huurman R, et al. Editor’s choice - systematic review and meta-analysis of the outcome of treatment for type Ⅱ endoleak following endovascular aneurysm repair. Eur J Vasc Endovasc Surg, 2018, 56(6): 794-807.
5.	Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.e72.
6.	Yokoyama Y, Kuno T, Takagi H. Meta-analysis of phase-specific survival after elective endovascular versus surgical repair of abdominal aortic aneurysm from randomized controlled trials and propensity score-matched studies. J Vasc Surg, 2020, 72(4): 1464-1472.e1466.
7.	Mulay S, Geraedts ACM, Koelemay MJW, et al. Type 2 endoleak with or without intervention and survival after endovascular aneurysm repair. Eur J Vasc Endovasc Surg, 2021, 61(5): 779-786.
8.	Branzan D, Geisler A, Steiner S, 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.e1971.
9.	Piazza M, Squizzato F, Zavatta M, et al. Outcomes of endovascular aneurysm repair with contemporary volume-dependent sac embolization in patients at risk for type Ⅱ endoleak. J Vasc Surg, 2016, 63(1): 32-38.
10.	Piazza M, Frigatti P, Scrivere P, et al. Role of aneurysm sac embolization during endovascular aneurysm repair in the prevention of type Ⅱ endoleak-related complications. J Vasc Surg, 2013, 57(4): 934-941.
11.	Abularrage CJ, Crawford RS, Conrad MF, et al. Preoperative variables predict persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg, 2010, 52(1): 19-24.
12.	中华医学会外科学分会血管外科学组. 腹主动脉瘤诊断和治疗中国专家共识 (2022版). 中国实用外科杂志, 2022, 42(4): 380-387.
13.	Moulakakis KG, Klonaris C, Kakisis J, et al. Treatment of type Ⅱ endoleak and aneurysm expansion after EVAR. Ann Vasc Surg, 2017, 39: 56-66.
14.	Guo Q, Zhao J, Ma Y, et al. A meta-analysis of translumbar embolization versus transarterial embolization for type Ⅱ endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg, 2020, 71(3): 1029-1034.e1021.
15.	Akmal MM, Pabittei DR, Prapassaro T, et al. A systematic review of the current status of interventions for type Ⅱ endoleak after EVAR for abdominal aortic aneurysms. Int J Surg, 2021, 95: 106138. doi: 10.1016/j.ijsu.2021.106138.
16.	Charisis N, Bouris V, Conway AM, et al. A systematic review and pooled meta-analysis on the incidence and temporal occurrence of type Ⅱ endoleak following an abdominal aortic aneurysm repair. Ann Vasc Surg, 2021, 75: 406-419.
17.	Ide T, Masada K, Kuratani T, et al. Risk analysis of aneurysm sac enlargement caused by type Ⅱ endoleak after endovascular aortic repair. Ann Vasc Surg, 2021, 77: 208-216.
18.	Samura M, Morikage N, Otsuka R, 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.
19.	Samura M, Morikage N, Mizoguchi T, et al. Identification of anatomical risk factors for type Ⅱ endoleak to guide selective inferior mesenteric artery embolization. Ann Vasc Surg, 2018, 48: 166-173.
20.	Zanchetta M, Faresin F, Pedon L, et al. Intraoperative intrasac thrombin injection to prevent type Ⅱ endoleak after endovascular abdominal aortic aneurysm repair. J Endovasc Ther, 2007, 14(2): 176-183.
21.	Dosluoglu HH, Rivero M, Khan SZ, et al. Pre-emptive nonselective perigraft aortic sac embolization with coils to prevent type Ⅱ endoleak after endovascular aneurysm repair. J Vasc Surg, 2019, 69(6): 1736-1746.
22.	Abularrage CJ, Patel VI, Conrad MF, et al. Improved results using Onyx glue for the treatment of persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg, 2012, 56(3): 630-636.
23.	陈永辉, 戴向晨. Ⅱ型内漏的治疗和预防方法及其应用材料的研究进展. 血管与腔内血管外科杂志, 2021, 7(3): 325-331.

1. Lederle FA, Kyriakides TC, Stroupe KT, et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med, 2019, 380(22): 2126-2135.
2. Schanzer A, Oderich GS. Management of abdominal aortic aneurysms. N Engl J Med, 2021, 385(18): 1690-1698.
3. Seike Y, Matsuda H, Shimizu H, et al. Nationwide analysis of persistent type Ⅱ endoleak and late outcomes of endovascular abdominal aortic aneurysm repair in Japan: A Propensity-Matched Analysis. Circulation, 2022, 145(14): 1056-1066. doi: 10.1161/CIRCULATIONAHA.121.056581.
4. Ultee KHJ, Büttner S, Huurman R, et al. Editor’s choice - systematic review and meta-analysis of the outcome of treatment for type Ⅱ endoleak following endovascular aneurysm repair. Eur J Vasc Endovasc Surg, 2018, 56(6): 794-807.
5. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.e72.
6. Yokoyama Y, Kuno T, Takagi H. Meta-analysis of phase-specific survival after elective endovascular versus surgical repair of abdominal aortic aneurysm from randomized controlled trials and propensity score-matched studies. J Vasc Surg, 2020, 72(4): 1464-1472.e1466.
7. Mulay S, Geraedts ACM, Koelemay MJW, et al. Type 2 endoleak with or without intervention and survival after endovascular aneurysm repair. Eur J Vasc Endovasc Surg, 2021, 61(5): 779-786.
8. Branzan D, Geisler A, Steiner S, 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.e1971.
9. Piazza M, Squizzato F, Zavatta M, et al. Outcomes of endovascular aneurysm repair with contemporary volume-dependent sac embolization in patients at risk for type Ⅱ endoleak. J Vasc Surg, 2016, 63(1): 32-38.
10. Piazza M, Frigatti P, Scrivere P, et al. Role of aneurysm sac embolization during endovascular aneurysm repair in the prevention of type Ⅱ endoleak-related complications. J Vasc Surg, 2013, 57(4): 934-941.
11. Abularrage CJ, Crawford RS, Conrad MF, et al. Preoperative variables predict persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg, 2010, 52(1): 19-24.
12. 中华医学会外科学分会血管外科学组. 腹主动脉瘤诊断和治疗中国专家共识 (2022版). 中国实用外科杂志, 2022, 42(4): 380-387.
13. Moulakakis KG, Klonaris C, Kakisis J, et al. Treatment of type Ⅱ endoleak and aneurysm expansion after EVAR. Ann Vasc Surg, 2017, 39: 56-66.
14. Guo Q, Zhao J, Ma Y, et al. A meta-analysis of translumbar embolization versus transarterial embolization for type Ⅱ endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg, 2020, 71(3): 1029-1034.e1021.
15. Akmal MM, Pabittei DR, Prapassaro T, et al. A systematic review of the current status of interventions for type Ⅱ endoleak after EVAR for abdominal aortic aneurysms. Int J Surg, 2021, 95: 106138. doi: 10.1016/j.ijsu.2021.106138.
16. Charisis N, Bouris V, Conway AM, et al. A systematic review and pooled meta-analysis on the incidence and temporal occurrence of type Ⅱ endoleak following an abdominal aortic aneurysm repair. Ann Vasc Surg, 2021, 75: 406-419.
17. Ide T, Masada K, Kuratani T, et al. Risk analysis of aneurysm sac enlargement caused by type Ⅱ endoleak after endovascular aortic repair. Ann Vasc Surg, 2021, 77: 208-216.
18. Samura M, Morikage N, Otsuka R, 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.
19. Samura M, Morikage N, Mizoguchi T, et al. Identification of anatomical risk factors for type Ⅱ endoleak to guide selective inferior mesenteric artery embolization. Ann Vasc Surg, 2018, 48: 166-173.
20. Zanchetta M, Faresin F, Pedon L, et al. Intraoperative intrasac thrombin injection to prevent type Ⅱ endoleak after endovascular abdominal aortic aneurysm repair. J Endovasc Ther, 2007, 14(2): 176-183.
21. Dosluoglu HH, Rivero M, Khan SZ, et al. Pre-emptive nonselective perigraft aortic sac embolization with coils to prevent type Ⅱ endoleak after endovascular aneurysm repair. J Vasc Surg, 2019, 69(6): 1736-1746.
22. Abularrage CJ, Patel VI, Conrad MF, et al. Improved results using Onyx glue for the treatment of persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg, 2012, 56(3): 630-636.
23. 陈永辉, 戴向晨. Ⅱ型内漏的治疗和预防方法及其应用材料的研究进展. 血管与腔内血管外科杂志, 2021, 7(3): 325-331.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Intraoperative sac embolizaion with coils and fibrin glue during endovascular aneurysm repair for preventing postoperative type Ⅱ endoleak

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