Endovascular management of endotension by graft reinforcement followed by direct sac embolization

• Published in: Minimally invasive therapy and allied technologies 2019-07, Vol.28 (4), p.234-240
• Main Authors: Nakai, Motoki, Ikoma, Akira, Loffroy, Romaric, Kamisako, Atsufumi, Higashino, Nobuyuki, Sonomura, Tetsuo
• Format: Article
• Language: English
• Subjects: Abdominal aortic aneurysm; Aged; Aortic Aneurysm, Abdominal; Biological Physics; Blood Vessel Prosthesis Implantation; Embolization, Therapeutic; Endotension; Endovascular Procedures; EVAR; Female; Follow-Up Studies; Graft reinforcement; Humans; Male; Middle Aged; Percutaneous direct sac embolization; Physics; Time Factors; Tomography, X-Ray Computed; Transplants; Treatment Outcome
• ISSN: 1364-5706; 1365-2931
• DOI: 10.1080/13645706.2018.1518918

Purpose: To assess the efficacy of graft reinforcement followed by percutaneous direct sac embolization (PDSE) for the treatment of endotension after endovascular abdominal aortic aneurysm repair (EVAR). Materials and methods: A total of 290 patients underwent elective EVAR. All patients regularly underwent scheduled surveillance with contrast-enhanced computed tomography (CT). Two hundred thirty-five patients were followed for ≥24 months after EVAR. Aneurysmal sac expansion of ≥10 mm was observed in 20 patients. The patients with sac expansion of ≥10 mm with no evidence of endoleak were treated with graft reinforcement. Graft reinforcement consisted of graft extension and graft relining. The patients with sac expansion at 6 months after graft reinforcement received PDSE using metallic coils and n-butyl cyanoacrylate-Lipiodol mixture. The aneurysm diameter was measured by CT performed 6 months and every year after the final intervention. Results: Seven patients (7 men, 0 women; mean age, 69.1 ± 4.2 years, Zenith ® :5/Excluder ® :1/Powerlink ® :1) underwent graft reinforcement. Two patients underwent graft reinforcement alone, and five patients underwent PDSE after graft reinforcement. Mean follow-up time after the final intervention was 21.1 months. The sac diameter stabilized after the final intervention in all patients. Conclusion: Graft reinforcement followed by complementary PDSE could be a useful treatment strategy for endotension.