Transcaval embolisation of type-II endoleaks - The Australian experience

ObjectivesEmbolizing an abdominal aortic aneurysm sac through a transcaval approach is a novel approach to treat type-II endoleaks that occur following aortic endografting. This study reviews the outcomes of this treatment in one of the few centres in Australia that offers this procedure.MethodsA retrospective cohort study was conducted, including patients who had received transcaval embolisation of type-II endoleak over a 9-year period. The primary outcome was clinical success, defined as the absence of endoleak on post-procedural ultrasonography at 6-weeks, provided the procedure was successfully completed. Other outcomes included clinical success at 1-year, aneurysm size, rupture and aneurysm-related mortality.ResultsTwelve patients with type-II endoleak and AAA sac growth received transcaval embolisation. Technical success was achieved in 91.7% of cases, in which both Onyx 34 and coils were deployed into the sac. Clinical success, defined as an absence of endoleak on ultrasonography 6-weeks after a technically successful procedure, was achieved in 66.7% of patients, none of whom had evidence of endoleak at 1-year post-procedure. In patients whom clinical success was achieved, there was a decrease in sac size during follow-up, from 72.5 ± 13.1 at 6-weeks to 66.0 ± 12.1 at 1-year post-procedure. Aneurysm sac size continued to enlarge if clinical success was not observed, with an average sac size of 72.0 ± 14.1 at 6-weeks increasing to 76.9 ± 15.2 at 1-year. No patients suffered AAA rupture or AAA-related mortality during follow-up.ConclusionsThis study reports a high technical and clinical success rate, with outcomes that could suggest that this procedure could induce sac regression.