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Objective: The purpose of this study is to evaluate the effectiveness of translumbar glue embolization(GE) of type II endoleaks in patients with growing aneurysms after EVAR.
Methods: Thirteen patients (mean age 78±7.1 years;77% male) with documented type II endoleaks on computed tomography(CT) scan and growing aneurysms after EVAR were retrospectively identified. All patients had post-EVAR growth ≥5mm. The patients underwent attempted translumbar angiogram(TLA) and GE of the type II endoleak with n-butyl cyanocrylate glue(nBCA). Co-morbidities of the patient cohort included hypertension(93%), diabetes(31%), hyperlipidemia(62%), coronary artery disease (69%), and renal failure(15%). Average follow-up after embolization was 21±16 months (range 4-66 months).
Results: A type II endoleak nidus with outflow vessels was identified in 9/13(69%) patients and TLA. All nine were successfully embolized with nBCA (group 1). In 4/13(31%) patients no clear endoleak nidus was identified on TLA, and nBCA glue was blindly injected into the aneurysm sac (group 2). In 9/9(100%) patients in group 1, aneurysm sac size stabilized or shrunk (7.1±1.2cm to 6.5±1.4cm) over a mean time period of 16±9 months. In 2/4(50%) of the group 2 patients, the aneurysm sac continued to grow despite blind GE, and open ligation of back bleeding vessels was performed. The remaining 2 patients in group 2 stabilized aneurysm growth over 19±7 months. There was no evidence of spinal ischemia, colon ischemia, or hemorrhage from GE in either group.
Conclusions: TLA and GE of a type II endoleak nidus is safe and can stabilize growing AAAs after EVAR. Blind sac GE of a type 2 endoleak without identification of an endoleak nidus may not stabilize growing AAAs after EVAR. Patients with continued AAA growth after TLA and GE may be successfully treated with open ligation of the back bleeding vessels.