Transcaval embolization as the preferred approach

The management of type II endoleaks that develop after endovascular repair of aortic aneurysms now includes the transcaval approach. We reviewed the safety and efficacy of this technique in 10 consecutive patients (82 ± 7 years old; 80% male) who presented with a mean sac enlargement of 1.2 ± 0.7 cm and documented flow within the aortic sac. Patients presented a mean of 5.5 ± 3.1 years after endovascular aneurysm repair, and five (50%) patients had prior attempts at endovascular repair of the documented endoleak. Patients underwent a percutaneous transcaval approach to the aorta with use of the Rösch-Uchida Transjugular Liver Access Kit (Cook Medical, Bloomington, Ind) through an 8F sheath in a biplane angiography room. Coil embolization of the sac and lumbar arteries and occasional use of gelatin granules and human thrombin slurry allowed obliteration of the endoleak. No complications developed. Nine patients (90%) were noted to have a decreased sac diameter on the postprocedure study, and only one (10%) had persistent (but markedly diminished) flow noted on the follow-up ultrasound examination. Follow-up is early and extends to 6 months without recurrence of the endoleaks. The ability to safely access the aortic sac through the vena cava is a potentially efficient, safe, and useful technique to treat aortic endoleaks.