Coiling a Type II Endoleak
A 76-year-old woman with a history of endovascular aortic aneurysm repair was monitored for an enlarging aneurysm sac and a type II endoleak.
Because of the location of the previously placed stent graft and the endoleak (Figure 1), an endovascular approach via the left internal iliac artery was selected. Using a 5-F, 0.038-inch inner diameter selective diagnostic catheter, the origin of the left iliolumbar artery was identified with a contrast injection (Figure 2). Because of the small diameter and the significant tortuosity of the origin of the iliolumbar artery, the 5-F catheter was advanced only slightly beyond the origin of the vessel.
An 0.021-inch inner lumen diameter Direxion™ J-shaped Microcatheter (Boston Scientific Corporation) and a torqueable 0.016-inch Angled Fathom®-16 Steerable Guidewire (Boston Scientific Corporation) were passed through the diagnostic catheter into the iliolumbar artery. After significant catheter and wire manipulation through the anastomosis with the left lumbar artery, access to the sac was achieved, and a contrast injection revealed a large aneurysmal void that was causing the endoleak (Figures 3A and 3B). After positioning the microcatheter within the aneurysm and removing the guidewire, the process of embolizing both the sac and the feeding vasculature began (Figure 4).
The embolization procedure was completed using a number of Interlock™-18 Fibered Platinum Coils (Boston Scientific Corporation), each with a wide diameter and a long length to ensure adequate wall apposition. Using a total of six coils, 210 cm of coil were rapidly deployed in both the endoleak channel and feeding vessel, and occlusion of the type II endoleak was achieved (Figure 5).
Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.
David Allison, MD
Peachtree Vascular Specialists