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CardioVascular and Interventional Radiology

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28-12-2023 | Aortic Aneurysm | Short Communication

Effectiveness of Intra-operative Contrast-Enhanced Ultrasound Assessment to Optimize Type II Endoleak Embolization

Authors: Guilherme B. Barbosa-Lima, Gustavo S. Oderich, Marina Dias-Neto, Emanuel R. Tenorio, Giulianna B. Marcondes, Bernardo C. Mendes, Pinar Ozbek, Thanila A. Macedo

Published in: CardioVascular and Interventional Radiology | Issue 3/2024

Abstract

Purpose

To analyze the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS).

Methods

Consecutive patients treated for T2E underwent a standardized protocol with trans-arterial or trans-lumbar access, large volume embolization, onlay fusion, and intra-operative CEUS. Technical success was defined by exclusion of endoleak by CEUS.

Results

Twenty-six patients (mean age 81 ± 11 years old; 89% male) were treated. The mean aneurysm sac enlargement was 11 ± 8 mm from T2E diagnosis. Embolization was performed using Onyx® 18 in all patients with adjunctive coils in 13 patients (50%). After the first embolization, CEUS documented residual T2E in 13 patients (50%). Ten patients (38%) had additional embolization, which successfully eradicated the T2E in seven of them. Technical success was 50% after the first embolization attempt and 77% after additional attempts guided by CEUS (P = 0.080). There was no mortality. Median imaging follow-up was 22 months. Among the 20 patients with no residual T2E on completion CEUS, 16 (80%) had sac stabilization and none required additional interventions for T2E. Of the six patients with residual T2Es on CEUS, three had sac stabilization (50%) and one required additional reintervention for T2E. There was one late aortic rupture at 56 months.

Conclusion

One in two patients treated by T2E embolization had residual endoleak on intra-operative CEUS after a first embolization attempt, decreasing to one in four patients after multiple attempts. A negative completion CEUS following embolization was associated with higher rates of sac stabilization and no need for additional T2E embolization.

Graphical Abstract

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Title: Effectiveness of Intra-operative Contrast-Enhanced Ultrasound Assessment to Optimize Type II Endoleak Embolization
Authors: Guilherme B. Barbosa-Lima
Gustavo S. Oderich
Marina Dias-Neto
Emanuel R. Tenorio
Giulianna B. Marcondes
Bernardo C. Mendes
Pinar Ozbek
Thanila A. Macedo
Publication date: 28-12-2023
Publisher: Springer US
Keywords: Aortic Aneurysm
Aortic Aneurysm
Aneurysm
Unruptured Cerebral Aneurysm
CT Angiography
Aortic Rupture
Published in: CardioVascular and Interventional Radiology / Issue 3/2024
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-023-03636-2

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Effectiveness of Intra-operative Contrast-Enhanced Ultrasound Assessment to Optimize Type II Endoleak Embolization

Abstract

Purpose

Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Graphical Abstract

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