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CardioVascular and Interventional Radiology

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01-04-2015 | Technical Note

Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

Authors: Yuya Koike, Jun-ichi Nishimura, Soichiro Hase, Motoshige Yamasaki

Published in: CardioVascular and Interventional Radiology | Issue 2/2015

Abstract

Purpose

The purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.

Methods

A retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.

Results

Sac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.

Conclusions

EVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

Ten Bosch JA, Teijink J, Willingendael E et al (2010) Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients. J Vasc Surg 52:13–18CrossRefPubMed

Brandt M, Walluscheck KP, Lajhnke T, Graw K et al (2005) Endovascular repair of ruptured abdominal aortic aneurysm: feasibility and impact on early outcome. J Vasc Interv Radiol 16:1309–1312CrossRefPubMed

Mehta M, Darling RC III, Roddy SP et al (2005) Factors associated with abdominal compartment syndrome complicating endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 42:1047–1051CrossRefPubMed

Berland TL, Veith FJ, Cayne NS, Mehta M, Mayer D, Lachat M (2013) Technique of supraceliac balloon control of the aorta during endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 57:272–275CrossRefPubMed

Koike Y, Nishimura J, Nishimaki H et al (2013) Use of the Endurant stent graft system for ruptured infrarenal aortic aneurysms: short-term experience in nine patients. J Vasc Interv Radiol 24:1462–1469CrossRefPubMed

Zanchetta M, Faresin F, Pedon L, Ronsivalle S (2007) Intraoperative intrasac thrombin injection to prevent type II endoleak after endovascular abdominal aortic aneurysm repair. J Endovasc Ther 14:176–183CrossRefPubMed

Ronsivalle S, Faresin F, Franz F, Rettore C, Zanchetta M, Olivieri A (2010) Aneurysm sac “thrombization” and stabilization in EVAR: a technique to reduce the risk of type II endoleak. J Endovasc Ther 17:517–524CrossRefPubMed

Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE (2004) N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol 15:689–695CrossRefPubMed

Yonemitsu T, Kawai N, Sato M, Tanihata H, Takasaka I et al (2009) Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and N-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol 20:1176–1187CrossRefPubMed

10.

Rusius VC, Davies RS, Hopkins JD et al (2011) Successful glue embolization of a late type Ia endoleak causing abdominal aortic aneurysm rupture. Vasc Endovasc Surg 45:198–201CrossRef

11.

Lehmkuhl L, Andres C, Lücke C et al (2013) Dynamic CT angiography after abdominal aortic endovascular aneurysm repair: influence of enhancement patterns and optimal bolus timing on endoleak detection. Radiology 268:890–899CrossRefPubMed

12.

Habets J, Zandvoort HJ, Reitsma JB, Bartels LW, Moll FL, Leiner T, van Herwaarden JA (2013) Magnetic resonance imaging is more sensitive than computed tomography angiography for the detection of endoleaks after endovascular abdominal aortic aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg 45:340–350CrossRefPubMed

13.

Bush RL, Lin PH, Ronson RS, Conklin BS, Martin LG, Lumsden AB (2001) Colonic necrosis subsequent to catheter-directed thrombin embolization of the inferior mesenteric artery via the superior mesenteric artery: a complication in the management of a type II endoleak. J Vasc Surg 34:1119–1122CrossRefPubMed

14.

Jonker FH, Aruny J, Muhs BE (2009) Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg 22:165–171CrossRefPubMed

Title: Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm
Authors: Yuya Koike
Jun-ichi Nishimura
Soichiro Hase
Motoshige Yamasaki
Publication date: 01-04-2015
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 2/2015
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-014-0873-6

At a glance: The STEP trials

Springer Medicine

Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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