Transcatheter Embolisation of Type 1 Endoleaks after Endovascular Aortic Aneurysm Repair with Onyx: When No Other Treatment Option is Feasible

Chun J-Y, Morgan R (St George’s Hosp, London, UK) Eur J Vasc Endovasc Surg 45:141-144, 2013^§

Abstract

Type 1 endoleaks following endovascular aortic aneurysm repair are associated with poor outcomes and re-intervention is recommended as soon as possible after diagnosis. When standard endovascular or surgical treatment options are unsuitable due to severe co-morbidity or adverse anatomic factors, patients can be treated by transcatheter embolisation of the endoleak itself. We describe six such patients with proximal and distal type 1 endoleaks, who have been successfully treated by transcatheter embolisation with Onyx. The embolisation technique, advantages of using this relatively novel liquid embolic agent and potential pitfalls are discussed (Fig 1).

Figure 1 (a) Completion angiogram following placement of Ventana fenestrated aortic endograft shows a proximal type 1 endoleak (arrows) and occluded left renal fenestration. (b) Entry into the proximal type 1 endoleak was achieved with a sidewinder catheter (white arrowheads). Selective angiography demonstrated the extent of the endoleak cavity (black arrows). (c) A more stable position was obtained within the endoleak cavity with a microcatheter (black arrows). Onyx was injected slowly into the deepest component of the endoleak initially and the microcatheter tip was subsequently withdrawn gradually during further slow injection. (d) Completion angiogram shows no residual endoleak after embolisation with 7 ml of Onyx. (Reprinted from European Journal of Vascular and Endovascular Surgery. Chun J-Y, Morgan R. Transcatheter embolisation of type 1 endoleaks after endovascular aortic aneurysm repair with onyx: when no other treatment option is feasible. Eur J Vasc Endovasc Surg. 2013;45:141-144, Copyright 2013, with permission from European Society for Vascular Surgery.)

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