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European Radiology
Published in: European Radiology 6/2014

01-06-2014 | Vascular-Interventional

Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

Authors: Christopher Bangard, Mareike Franke, Roman Pfister, Antje-Christin Deppe, Vladimir Matoussevitch, David Maintz, De-Hua Chang

Published in: European Radiology | Issue 6/2014

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Abstract

Objectives

To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR.

Methods

A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed.

Results

Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac.

Conclusions

Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible.

Key Points

• Endoleaks after thoracic endovascular aortic repair are common in 15-30 %.
• Most endoleaks can be treated by endovascular means.
• Direct percutaneous endoleak repair is described as a bail-out option.
• Direct percutaneous aortic arch coil embolisation of type 1a endoleak is possible.
• Antibiotic prophylaxis should be administered case by case, considering individual risk factors.
Literature
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Waterman AL, Feezor RJ, Lee WA et al (2012) Endovascular treatment of acute and chronic aortic pathology in patients with Marfan syndrome. J Vasc Surg 55:1234–1240PubMedCrossRef
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Venkatesan AM, Kundu S, Sacks D et al (2010) Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol 21:1611–1630PubMedCrossRef
Metadata
Title
Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts
Authors
Christopher Bangard
Mareike Franke
Roman Pfister
Antje-Christin Deppe
Vladimir Matoussevitch
David Maintz
De-Hua Chang
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3143-8

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