Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer.

Abstract

BACKGROUND:

 Type 2 endoleaks (T2EL) are the most frequent complication following endovascular aortic repair. Multiple studies primarily deal with the technical and clinical success of the embolization of persisting T2EL, thereby revealing controversial outcomes. Current reports rarely focus on the detailed execution of such a complex interventional procedure with respect to the difficult anatomic setting.

METHODS:

 The present review provides an in-depth depiction and evaluation of the interventional methodology of the embolization of T2EL in the abdominal aorta with use of ethylene vinyl alcohol copolymer (EVOH). Complicating anatomic conditions are taken into account as well as technical and clinical success rates.

RESULTS:

 Using the transarterial approach, there are at least 4 different pathways to access the nidus of a T2EL. CT-guided direct puncture of the aneurysm sac provides an alternative method of high technical success. EVOH with its slow solidification characteristics enables good control to achieve complete filling of the T2EL. During the intervention, however, it remains difficult to meet exactly the embolization endpoint, especially in large T2ELs.

CONCLUSION:

 T2EL embolization using EVOH is an effective treatment with low major complication rates when conducted by skilled interventionists with detailed knowledge of diverse complex access routes.

KEY POINTS:

  · Many roads lead to Rome to access the nidus of a T2EL including diverse complex transarterial pathways and direct aneurysm sac puncture.. · Ethylene vinyl alcohol co-polymer enables good control for slow filling of the nidus with low risk of major complications.. · Identification of the embolization endpoint remains difficult during the procedure and may result in secondary interventions.. · Successful T2EL embolization requires detailed knowledge of all access routes to the nidus and skilled handling of liquid embolics..

CITATION FORMAT:

· Nolte-Ernsting C, Mecklenbeck F, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. Fortschr Röntgenstr 2021; 193: 1426 - 1435.

• Authors: Claus Nolte-Ernsting, Frank-Peter Mecklenbeck, Alexander Stehr
• Journal: RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin (Rofo) Vol. 193 Issue 12 Pg. 1426-1435 (Dec 2021) ISSN: 1438-9010 [Electronic] Germany
• Vernacular Title: Embolisation von Typ-2-Endoleaks der Bauchaorta mit Ethylen-Vinylalkohol-Copolymer.
• PMID: 34139782 (Publication Type: Journal Article, Review)
• Copyright: Thieme. All rights reserved.

Chemical References

• Polyvinyls
• ethylene-vinyl alcohol copolymer

Topics

• Aorta, Abdominal
• Aortic Aneurysm, Abdominal (diagnostic imaging, surgery)
• Blood Vessel Prosthesis Implantation
• Endoleak (surgery, therapy)
• Endovascular Procedures
• Humans
• Polyvinyls
• Retrospective Studies
• Time Factors