Treatment of Type II Endoleak After Endovascular Aneurysm Repair: The Role of Selective vs. Nonselective Transcaval Embolization

Purpose: To assess the technical and midterm results in the treatment of type II endoleaks comparing nonselective (nTCE) vs. selective (sTCE) transcaval embolization. Methods: During a 4-year period, 26 patients (18 men; median age 73 years, range 68-78) underwent direct transcaval aneurysm puncture followed by embolization of the sac (nTCE, n) or of the feeding vessels (sTCE, n=17). Intrasac pressure was recorded immediately after aneurysm sac puncture and at the end of the procedure. Technical success was defined as successful deployment of embolization material in the sac or in the feeding vessel. Clinical success was defined as absence of endoleak with stabilization of the sac on follow-up CTA. Results: Technical success was 100% in the 9 patients treated with nTCE. Mean intrasac pressures before and after nTCE were 58.6 +/- 18.4 (range 51-105) and 6.5 +/- 1.2 mmHg (range 4-9), respectively. Over a mean 25.9 +/- 11.0 months of follow-up, 4 patients developed recurrent endoleak at a mean 9.7 +/- 3.9 months. Three patients were subsequently treated with sTCE, while the last patient underwent emergency surgery for aneurysm rupture due to an enlarging sac 5 months after nTCE. The 20 patients in the sTCE group had a successful procedure with no recurrence in a follow-up of 24.1 +/- 7.2 months. Mean intrasac pressure was reduced after sTCE from 63.6 +/- 15.2 mmHg (range 43-120) to 7.8 +/- 2.3 mmHg (range 5-12). Conclusion: The selective TCE approach appears to be a feasible and effective primary therapeutic option for treating type II endoleak.