Back to Annual Meeting Posters

Translumbar embolization utilizing interlock coils to treat type 2 endoleak after endovascular AAA repair
Matt Linger, BA; Kristopher Bagdasarian, MD; Saum A. Rahimi MD; Paul B. Haser MD and Alan M. Graham MD
Division of Vascular Surgery, Robert Wood Johnson Medical School,
New Brunswick NJ 08901
Objective
There is consensus that type 2 endoleaks after EVAR should be treated if there is sac enlargement; however, no standard has been set as to how to effectively treat these patients when this occurs. The objective of this study was to evaluate the technique of translumbar coil embolization and the effectiveness of the interlock coil in treating this difficult clinical problem.
Methods
We completed retrospective review of patients who were treated with translumbar coil embolization from 2009-2011 for enlarging aortic aneurysm sacs after endovascular repair secondary to type 2 endoleaks. The interlock coil system was used in all patients utilizing micro coils for selective IMA and lumbar embolization and the 0.035 in interlock coils to occlude flow channels within the aneurysm sac. Primary endpoints included endoleak resolution, change in aneurysm size and need for reintervention.
Results
A total of 12 translumbar coil embolizations were performed in ten patients for enlarging AAA sac size with type 2 endoleaks. The average sac pressure was 72mm Hg which did not have any significant change pre and post coil placement. Two patients required repeat translumbar coil embolization for persistent type 2 endoleak and continued sac growth. One of these patients required delayed open retroperitoneal intrasac ligation of lumbar arteries for the development of a symptomatic aneurysm with sac growth. The remaining 8 patients had stabilization of sac growth, in 6 patients there was resolution of the endoleak and in 2 patients the endoleak was still present but significantly reduced with a mean follow up of 12.5 months. There were no procedure related complications.
Conclusion
Translumbar AAA embolization utilizing interlock coils is a safe and effective procedure. Measurement of intrasac pressure does not seem to be predictive of endoleak resolution. Patients may require repeat treatment and if this fails should be offered surgical repair. Longer term follow up and comparison to other embolization materials is required to determine the most effective technique.