Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Experience of Persistent Type 2 Endoleaks with Aneurysmal Sac Enlargement after Endovascular Aneurysm Repair

  • Bang, Seung Ho (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Park, Jae Bum (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Chee, Hyun Keun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Jun Seok (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Jang, Il Soo (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine)
  • Received : 2013.08.16
  • Accepted : 2013.10.14
  • Published : 2014.04.05
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Abstract

Herein, we present a case of a successful treatment of persistent type 2 endoleaks associated with aneurysmal sac enlargement after endovascular aneurysm repair in an elderly patient. We confirmed the diagnosis by abdominal computed tomography and selective angiography revealing an 11.0-cm aneurysm sac with type 2 endoleaks. An attempt for the endovascular embolization of collateral arteries was unsuccessful due to anatomic variations and their multiple complex communications. Instead, transperitoneal sacotomy and direct suturing on the feeding target vessels was successfully performed without any endograft damage. In conclusion, sacotomy appears to be a feasible therapeutic substitute where endovascular or other techniques have a high risk of failure and lead to unsuccessful results.

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References

  1. EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005; 365:2179-86. https://doi.org/10.1016/S0140-6736(05)66627-5
  2. Jones JE, Atkins MD, Brewster DC, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg 2007;46:1-8. https://doi.org/10.1016/j.jvs.2007.02.073
  3. El Batti S, Cochennec F, Roudot-Thoraval F, Becquemin JP. Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg 2013;57:1291-8. https://doi.org/10.1016/j.jvs.2012.10.118
  4. Sarac TP, Gibbons C, Vargas L, et al. Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg 2012;55:33-40. https://doi.org/10.1016/j.jvs.2011.07.092
  5. Jonker FH, Aruny J, Muhs BE. Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg 2009;22:165-71. https://doi.org/10.1053/j.semvascsurg.2009.07.008
  6. Hinchliffe RJ, Singh-Ranger R, Whitaker SC, Hopkinson BR. Type II endoleak: transperitoneal sacotomy and ligation of side branch endoleaks responsible for aneurysm sac expansion. J Endovasc Ther 2002;9:539-42. https://doi.org/10.1583/1545-1550(2002)009<0539:TIETSA>2.0.CO;2
  7. Ferrari M, Sardella SG, Berchiolli R, et al. Surgical treatment of persistent type 2 endoleaks, with increase of the aneurysm sac: indications and technical notes. Eur J Vasc Endovasc Surg 2005;29:43-6. https://doi.org/10.1016/j.ejvs.2004.10.008
  8. Faccenna F, Alunno A, Castiglione A, et al. Persistent type II endoleak: two cases of successful sacotomy. Ann Vasc Surg 2013;27:240.e9-240.e11.