Transealing: A novel and simple technique for embolization of type 2 endoleaks through direct sac access from the distal stent-graft landing zone

Objective: Type 2 endoleak (T2EL) is the Achilles' heel of endovascular abdominal aortic aneurysm repair. Experience with transealing, an alternative technique for the treatment of T2ELs, is described. Methods: The outcome of a group of patients treated with transealing has been reviewed. Femoral access was obtained with a 9-Fr sheath. A super-stiff guide wire and a stiff hydrophilic wire were placed inside the stent-graft and a Piton GC catheter inserted. The stiff hydrophilic wire was retrieved to allow the catheter to regain its curvature and the catheter tip was placed against the iliac wall, at the edge of the stent-graft. The hydrophilic wire was then forced between the stent-graft and arterial wall into the sac. A 5/6-Fr introducer was inserted inside the sac and angiography was performed to evaluate the leak. Coils, cyanoacrylate, or fibrin glue were deployed. After removal of the catheters, the iliac limb was ballooned. Results: Seventeen patients were treated between February 2009 and April 2013. It was possible to access the aneurysm in 16/17 attempts. One patient treated with acrylic glue suffered from colon ischemia. One intraoperative secondary type 1b endoleak was treated with an iliac extension. Mean follow-up was 21.5 months. Three months of follow-up were completed in 14 patients with a 53% freedom from endoleak rate. At 1 year, the rate was 45%. During the study period, there was one surgical conversion, one aneurysm growth, and one re-embolization procedure. The remaining leaks remained stable. Conclusions: This study shows that transealing is feasible and represents a valid alternative in selected patients. The advantages of this technique are mainly its low invasiveness, reduced costs, and ease of use. © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.