Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR)

Journal Article · Mon Jun 15 04:00:00 EDT 2015 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-015-1065-8· OSTI ID:22469947

Ogawa, Yukihisa; Hamaguchi, Shingo ^[1]; Nishimaki, Hiroshi ^[2]; Kon, Yuri ^[1]; Chiba, Kiyoshi; Sakurai, Yuka ^[2]; Murakami, Kenji; Arai, Yasunori ^[1]; Miyairi, Takeshi ^[2]; Nakajima, Yasuo ^[1]

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1. St. Marianna University, School of Medicine, Department of Radiology (Japan)
2. St. Marianna University, School of Medicine, Department of Cardiovascular Surgery (Japan)

BackgroundEndovascular aortic repair (EVAR) requires further intervention in 20-30 % of cases, often due to type II endoleak (T2EL). Management options for T2EL include transarterial embolization, direct puncture (DP), or transcaval embolization. We report the case of an 80-year-old man with T2EL who successfully underwent DP embolization.MethodsEmbolization by DP was performed with a transpedicular approach using an isocenter puncture (ISOP) method. An isocenter marker (ICM) was placed at a site corresponding to the aneurysm sac on fluoroscopy in two directions (frontal and lateral views). A vertebroplasty needle was inserted tangentially to the ICM under fluoroscopy and advanced to the anterior wall of the vertebral body. A 20 cm-length, 20-G-PTCD needle was inserted through the outer needle of the 13-G needle and advanced to the ICM. Sac embolization using 25 % N-buty-2-cyanoacrylate diluted with Lipiodol was performed. After complete embolization, rotational DA confirmed good filling of the sac with Lipiodol. The outer cannula and 13-G needle were removed and the procedure was completed.ResultsThe patient was discharged the next day. Contrast-enhanced computed tomography 1 and 8 months later showed no Lipiodol washout in the aneurysm sac, no endoleak recurrence, and no expansion of the excluded aneurysm.ConclusionDP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult.

• OSTI ID: 22469947
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 3 Vol. 38; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
COMPUTERIZED TOMOGRAPHY
FLUOROSCOPY
LIPIODOL
PATIENTS
VASCULAR DISEASES