Treatment of Type I Endoleaks after Endovascular Aneurysm Repair of Infrarenal Abdominal Aortic Aneurysm: Usefulness of N-butyl Cyanoacrylate Embolization in Cases of Failed Secondary Endovascular Intervention

Purpose: To evaluate the technical feasibility and effectiveness of N-butyl cyanoacrylate (NBCA) embolization using a percutaneous transabdominal or a transarterial approach in the failed secondary endovascular treatment of type I endoleaks after endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms. Materials and Methods: From 2000-2007, seven patients with failed secondary endovascular treatment of type 1 endoleaks (five patients with type Ia endoleak, one patient with type Ib endoleak, and one patient with type la and Ib endoleaks) were treated with embolization using NBCA with or without a coil. Embolizations were performed using either a percutaneous transabdominal (n = 5) or a transarterial (n = 5) approach. Four patients underwent a single session of embolization, and three underwent two sessions of embolization. The duration between EVAR and endoleak treatment was 9.6 months +/- 15.3 (mean +/- standard deviation; range 0-42 months). Follow-up computed tomography (CT) scans were evaluated for changes in size and shape of the aneurysm sac and presence or resolution of endoleaks. The follow-up period after endoleak treatment was 18.0 months +/- 20.4 (mean +/- standard deviation; range 0-53 months). Results: Technical success was achieved in six patients with complete resolution of the endoleak confirmed by follow-up CT scans. One technical failure was observed in a patient who eventually underwent surgical conversion. There were no procedure-related complications. Conclusions: Embolization with NBCA by a percutaneous transabdominal or a transarterial approach for the treatment of type I endoleaks after EVAR was technically feasible and clinically effective, with no major complications.