A Novel Technique and Outcomes for Transcaval Endoleak Embolization

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Aneurysm Repair

Background:

• Type 2 endoleaks after endovascular aneurysm repair (EVAR) require treatment.
• Translumbar, transgraft, and transarterial approaches have limitations.
• The transcaval approach offers an alternative but faces challenges in accessing the aortic sac and risks to surrounding structures.

Purpose of the Study:

• To describe a novel technique for transcaval access to the aortic sac for endoleak embolization.
• To report early outcomes of this new transcaval embolization (TCE) method.

Main Methods:

• Retrospective review of 12 patients undergoing TCE from March 2019 to June 2021.
• Utilized a 0.014″ wire guide and electrocautery for caval to aortic sac access.
• Embolization performed with coils or liquid agents; sac instillation if selective embolization failed.

Main Results:

• Successful transcaval access to the aortic sac in all 12 patients.
• Selective outflow vessel cannulation achieved in 16% of cases; nonselective embolization in 83%.
• 8.3% perioperative bleeding complication; 33.3% persistent endoleak at 30 days; 25% sac enlargement >5mm; 3 patients required open conversion/explant.

Conclusions:

• The novel electrified wire technique enables successful transcaval access for endoleak embolization with low acute morbidity.
• The approach remains limited by difficulties in selective outflow vessel catheterization.
• Persistent endoleaks and sac enlargement can occur, potentially leading to explantation.