Videolaparoscopic-Guided Saccography and Direct Sac Embolization After Standard EVAR

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Aneurysm Repair (EVAR)

Background:

• Type II endoleak (T2EL) after EVAR poses management challenges, often requiring intervention for sac enlargement.
• Existing T2EL treatments include various embolization techniques, but optimal strategies remain debated.

Purpose of the Study:

• To evaluate the efficacy and safety of videolaparoscopic-guided saccography and direct sac embolization (ViSE) for T2EL with sac enlargement post-EVAR.

Main Methods:

• Retrospective review of patients undergoing EVAR from 2016-2022.
• Inclusion of patients with T2EL and sac growth treated with ViSE, excluding specific contraindications.
• Analysis of procedure time, fluoroscopic time, technical success, and outcomes.

Main Results:

• ViSE achieved technical success in 87% of 14 patients.
• Inferior mesenteric artery (IMA) ligation was performed in 50% of cases.
• Occult type I or III endoleaks were identified in 35% of patients, requiring further intervention.

Conclusions:

• ViSE is a safe and effective alternative for managing T2EL with sac enlargement after EVAR.
• The technique aids in treating the nidus and IMA, and detecting hidden endoleaks.
• ViSE expands endovascular treatment options, potentially improving outcomes and reducing open conversions.