Purpose: To elucidate the safety and efficacy of embolization using N-butyl cyanoacrylate (NBCA) for endoleaks after abdominal/thoracic endovascular aortic repair (EVAR/TEVAR) via a direct percutaneous approach versus a transarterial approach.
Materials and Methods: The retrospective design of the study was approved by the institutional ethics committee, and the requirement for informed written consent was waived. Sixteen patients underwent embolization for endoleaks after EVAR/TEVAR, which was diagnosed as type II, from March 2010 to December 2013 at our institution. The number of embolization sessions was 21. A direct percutaneous approach was used in 10 sessions, and a transarterial approach was used in 11 sessions. There were 11 and 15 embolic sites for the two approaches, respectively. The procedure time, amount of contrast media used, therapeutic effect, and complications were evaluated.
Results: The mean procedure time (per embolic site) was 100 min (53-170) in the direct percutaneous approach, which was significantly shorter than the 191 min (76-275) in the transarterial approach. The mean amount of contrast media used during the procedure (per embolic site) was 12.8 ml (3-25) by the direct percutaneous approach, which was significantly lesser than the 71.8 ml (30-180) in the transarterial approach. Local control of the embolic site and interval increase in the size of aneurysm after embolization were not significantly different between the two approaches. In one case each, mesenteric hematoma and migration of the embolic agent occurred with a direct percutaneous approach, and a small arterial injury occurred with the transarterial approach; aneurysmal rupture/perianeurysmal hematoma and neurological dysfunction were not observed.
Conclusion: A direct percutaneous approach is a feasible procedure for embolization of endoleaks after EVAR/TEVAR.
This case report describes a 72-year-old man who developed an intra-abdominal abscess and major postoperative anastomotic leakage. He reported a history of pancreaticoduodenectomy, partial hepatectomy, and segmental colectomy for hepatic and colonic invasion of extrahepatic cholangiocarcinoma. Three catheters, (one in the transverse colon and two in the abscess cavity) were placed simultaneously through the drainage tract formed by the intraoperatively placed Pleats drain. The intra-abdominal abscess resolved following this intervention and has not recurred since. Postoperative drainage and starvation were continued for 52 and 84 days, respectively. This case report describes a novel technique of catheter insertion from the abscess cavity into the intestine through the site of rupture to reduce intestinal pressure and partially block the enteric fistula.
Pneumothorax and unintended arterial puncture are well-known complications of central venous (CV) access via the internal jugular vein (IJV), whereas injury to nerves around the IJV is a relatively rare complication. We describe the case of a male patient in his 60s who developed Horner syndrome after CV port placement via the IJV. We also point out the anatomical nerve structures around the IJV that clinicians should be aware of in order to minimize the risk of nerve injury during CV access. Additionally, with a brief literature review, we describe other nerve injuries that can be caused by CV access.
In this report, we present a rare case of type 2 endoleak (T2EL) from an artery supplying the psoas major muscle, following an endovascular repair of a common iliac artery aneurysm (CIAA). A 79-year-old male underwent endovascular aneurysm repair (EVAR) for the right isolated CIAA using stent graft, with embolization of the ipsilateral internal iliac artery. The aneurysm was stable for 2 years, after which a follow-up CT revealed a 5 mm increase in the CIAA diameter and an endoleak of unknown origin. Conventional and CT angiographies revealed the source to be a branch from the ipsilateral deep circumflex iliac artery supplying the psoas major muscle that had developed an anastomosis at its terminal end with the vasa vasorum at the CIAA. Transarterial embolization of T2EL using glue was performed successfully, following which the T2EL disappeared.
An 81-year-old woman presented with massive hemoptysis. She had a history of total arch replacement with an elephant trunk followed by concomitant antegrade thoracic endovascular aortic repair for the aortic arch and the descending aortic aneurysm. Computed tomography (CT) showed expansion of the aortic aneurysm with type II endoleak, lung parenchymal consolidation, and ground-glass opacity. An aortopulmonary fistula was suspected. Surgery posed a very high risk for the patient; hence, a less invasive approach was considered. Left subclavian arteriography revealed a type II endoleak. A transarterial approach would be difficult due to the small and tortuous access route and longer procedure time. Therefore, CT-guided puncture embolization was performed. She had no recurrence of hemoptysis for 1.4 years after the embolization.
Herein, we present a case of superior mesenteric artery (SMA) thrombus as a complication of stent placement for celiac stenosis and coil packing of a pancreaticoduodenal artery aneurysm. The SMA thrombus was likely caused by thromboembolism from the guiding sheath in the SMA without a continuous heparin flush. It was promptly treated with aspiration thrombectomy, and there was no mesenteric ischemia. To avoid thromboembolic complications, periprocedural prophylactic antithrombotic therapy should also have been performed because a complex procedure involving the pull-through technique was performed.