Transcaval endoleak embolization using intravascular ultrasound: A step-by-step guide

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Type II endoleaks are frequent complications after endovascular aneurysm repair (EVAR).
• Transarterial embolization is the standard treatment, but may fail in some cases.

Purpose of the Study:

• To review the indications and evaluation for transcaval endoleak embolization.
• To provide a step-by-step description of the transcaval embolization procedure.
• To discuss potential technical challenges and complications of the transcaval approach.

Main Methods:

• The transcaval approach involves accessing the aneurysm sac directly via venous access (internal jugular or femoral vein).
• Intravascular ultrasound or fluoroscopy guides needle access into the aneurysm.
• Embolization is performed using coils, liquid agents, or thrombin.

Main Results:

• The transcaval approach is generally well-tolerated by patients.
• Successful embolization of the endoleak source is achievable.
• Potential complications include iatrogenic type III endoleaks and infections.

Conclusions:

• The transcaval approach is a viable alternative for refractory type II endoleaks post-EVAR.
• Careful patient selection and procedural technique are crucial to minimize complications.
• Further studies may be warranted to fully elucidate long-term outcomes.