Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak

This study was undertaken to describe the technique of transfemoral superselective coil embolization of type II endoleak and its influence on abdominal aortic aneurysm diameter.

Over 23 months, 104 aortic stent grafts were deployed to exclude abdominal aortic aneurysms, at an academic medical center. Increase in aneurysm diameter and perigraft findings on contrast material-enhanced computed tomography scans prompted arteriography. Procedures were performed solely by vascular surgeons in a surgical angiography suite. In 7 patients aneurysm access was via the iliolumbar branches of the internal iliac artery, and in 1 patient aneurysm access was via the inferior mesenteric artery through the arc of Riolan from the superior mesenteric artery. Coaxial catheters were placed to gain access to the aneurysm (8F to 5F to 3F, or 5F to 3F). A 3F Tracker18 was the most distal catheter through which an assortment of 0.018 microcoils were deployed within the aneurysm, and the origin of the feeding vessels when possible.

Aneurysm diameter increased 0.48 +/- 0.2 cm over 10.8 +/- 5 months before superselective coil embolization. In 6 of 8 patients superselective coil embolization embolization resulted in a mean decrease in aneurysm diameter of 1.3 +/- 1.2 cm over 9 +/- 3.2 months. Failure was presumed due to inability to reach the aneurysm sac in 1 patient and was associated with oral anticoagulation in 1 other patient.

Proper identification of the source of type II endoleak and its complete occlusion, combined with aneurysm sac coiling, may result in prompt decrease in aneurysm size.