Author + information
- Satoru Nagatomi1
Patient initials or identifier number
Relevant clinical history and physical exam
This case is a 70-year-old female who had a history of hypertension, hyperlipidemia, and abdominal aortic aneurysm (AAA). Endovascular aortic repair (EVAR) and right internal iliac artery-external iliac artery bypass performed for AAA 2 years ago. During the follow-up period, aneurysmal sac enlarged with type 2 endoleak. His internal medicine contained no antiplatelet or anticoagulant angent.
Relevant test results prior to catheterization
Contrast-enhanced computed tomography showed the enlargement of the aneurysmal sac with type 2 endoleak due to right 4th lumbar artery and the other branches taking origination in the abdominal aorta. We planned transarterial embolization.
Relevant catheterization findings
Initial angiography of endoleak cavity revealed the feeding artery right 4th lumbar artery, left 4th lumbar artery and medial sacral artery.
With, the transfemoral approach, microcatheter system advanced from right iliolumbar artery to right 4th lumbar artery via collateral arcade. Finally, microcatheter reached endoleak cavity. Initial angiography of endoleak cavity revealed the feeding arteries: right 4th lumbar artery, left 4th lumbar artery, medial sacral artery. It was difficult to cannulate left 4th lumbar artery and medial sacral artery, then embolization of endoleak cavity and a right 4th lumbar artery was performed using glue (N-butyl-cyanoacrylate and lipiodol mixture).
On treatment of type 2 endoleak after endovascular aortic repair, it is probably desirable to exclude the endoleak cavity. Glue embolization considered useful in such a case. We experienced a case of successful transarterial embolization using glue for type 2 endoleak after endovascular aortic repair.