Abstract

Objective This study reports the technical success and follow-up results of transcatheter embolization of type I endoleak (ELI) in 25 patients after endovascular aortic repair (EVAR). Methods Twenty-five patients with ELI (20 men, five women; mean age 80 years; range, 64-96 years) underwent embolization of abdominal ELI (23 proximal, 2 distal endoleaks) after EVAR. All patients were unsuitable for standard endovascular methods for treatment of ELI. The average aneurysm sac size before embolization was 8.2 cm (range, 5.3-12.9 cm). The average time between EVAR and endoleak diagnosis was 685 days (range, 1-4220 days) and from endoleak diagnosis to embolization was 27 days (range, 2-94 days). Onyx (ev3 Endovascular, Inc, Plymouth, Minn) alone or with detachable coils was used for embolization. Results A total of 27 embolization procedures were performed, with two patients having undergone a repeat procedure. Onyx alone was used in 16 cases and Onyx and coils were used in 11. Immediate technical success with complete isolation of the endoleak on completion angiography was achieved in all procedures. Six procedural complications occurred: three puncture site hematomas and three cases of non-target Onyx embolization. None of the complications had long term sequelae. During the follow-up period (average, 311 days; range, 1-1357 days), seven patients (28%) developed endoleak recurrence, and two underwent a second embolization procedure. Of these, one has had no further endoleak recurrence, but the other developed a recurrent endoleak and died of sac rupture. Two of the other five cases of endoleak recurrence were successfully managed by other procedures, one had a persistent endoleak despite aortic cuff placement, and the other two were deemed unsuitable for further intervention. Three of the four patients with persistent endoleaks died of sac rupture. At the average follow-up time of 311 days, freedom from endoleak recurrence was 80%, and freedom from sac growth was 85%. Conclusions Transcatheter embolization of ELI offers a safe, feasible, and sustainable treatment option for patients who are unsuitable for standard methods of ELI treatment. Additional coil embolization before Onyx injection may result in better outcome.