Laser fenestration and shape memory polymer embolization of type II endoleaks

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Biomaterials Science

Background:

• Type II endoleaks (T2ELs) with abdominal aortic aneurysm (AAA) sac expansion require treatment, but durable endovascular options are limited.
• Shape memory polymer (SMP) embolization plugs offer rapid space-filling and thrombosis support for endovascular repair.

Purpose of the Study:

• To evaluate the efficacy of transendograft laser fenestration combined with SMP embolization for treating challenging T2ELs.
• To assess the rate of persistent abdominal aortic aneurysm sac growth at 1- and 6-month follow-up.

Main Methods:

• Retrospective review of seven patients undergoing transendograft laser fenestration and SMP embolization for T2ELs.
• Laser fenestration targeted endoleaks, followed by SMP plug deployment and endograft realignment.
• Primary outcome: persistent aneurysmal sac growth at 1- and 6-month follow-up.

Main Results:

• The cohort included patients with various prior aneurysm repairs and interventions.
• Median AAA diameter was 75.0 mm with significant prior growth.
• Three patients experienced continued AAA growth post-procedure, requiring reintervention; overall 6-month freedom from AAA growth was 42.9%.

Conclusions:

• Transendograft laser fenestration and SMP embolization achieved a 6-month freedom from AAA growth in approximately 43% of patients.
• Refractory T2ELs in complex aneurysmal disease present challenges.
• SMP embolization holds potential as a minimally invasive therapy for T2ELs with future procedural refinements.