J Korean Soc Radiol.  2014 Dec;71(6):310-313. 10.3348/jksr.2014.71.6.310.

Endovascular Treatment of Type II Endoleak Following Thoracic Endovascular Aortic Repair for Thoracic Aortic Aneurysm: Case Report of Squeeze Technique to Reach the Aneurysmal Sac

• Kang HJ
• Kim CW
• Lee TH
• Song SH
• Lee CW
• Chung SW

• KMID: 1801554
• DOI: http://doi.org/10.3348/jksr.2014.71.6.310

Abstract

Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

MeSH Terms

Aneurysm*
Aortic Aneurysm, Thoracic*
Arteries
Cyanoacrylates
Endoleak*
Punctures
Thrombin
Cyanoacrylates
Thrombin

Figure

• 

  Fig. 1 A-77-year-old woman with thoracic aortic aneurysm. A. CT angiography (CTA) image shows a 6.5-cm saccular aneurysm with discontinuous intima calcification in the descending thoracic aorta. B. Thoracic aortogram shows a 6.5-cm saccular aneurysm at the mid-thoracic level. C. Thoracic aortogram following thoracic endovascular aortic repair shows a delayed filling of the aneurysmal sac with blood flow from the left seventh intercostal artery, suggesting a type II endoleak. D. CTA shows an endoleak anterior to the stent-graft.

• 

  Fig. 2 Type II endoleak after thoracic endovascular aortic repair treated by histoacryl embolization. A. Thoracic angiogram shows a type II endoleak due to retrograde filling of the aneurysmal sac with blood flow from the left seventh intercostal artery. B, C. Cavitogram shows opacification of an aneurysmal sac and an efferent intercostal artery (black arrows). D. The aneurysmal sac and intercostal arteries was embolized with a mixture of histoacryl (3 mL) and lipiodol (9 mL). E. Postembolization angiogram shows a complete resoultion of the endoleak. F, G. An unchanged saccular aneurysm and a complete resolution of the endoleak are seen on noncontrast (F) and contrast-enhanced (G) CT scans.

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  Fig. 3 The diagram shows a 2.0-Fr microcatheter (Progreat; Terumo, Tokyo, Japan) with a 0.18-inch guide wire (Transend; Boston Scientific, Boston, MA, USA), advanced into the aneurysmal sac between the distal end of the stent-graft and the aortic wall by squeezing the very narrow space.

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