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Surgical management of extensive thoracoabdominal aortic aneurysms is associated with high rates of mortality and morbidity, including spinal cord ischemia. We report a successful three-stage repair combining open and endovascular surgery in a patient presenting with an ascending, arch, and thoracoabdominal aneurysm. Spinal cord protective measures included a staged approach, preserved antegrade flow to the left subclavian and hypogastric arteries, absence of aortic cross-clamping, and aggressive perioperative hemodynamic monitoring., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Purpose: We report the procedural details and immediate results of treatment of type II endoleaks after aortic stent-graft implantation., Methods: In a consecutive series of patients who had either Vangard (n = 53) or Talent (n = 7) aortic stent-grafts implanted, type II endoleaks were confirmed by means of angiography in 18 patients, with a mean (+/- SD) age of 69 +/- 11 years; 16 patients had Vangard stent-grafts, and two patients had Talent stent-grafts. After superselective catheterization of the feeding vessel, with 3F microcatheters, and liberal injections of vasodilators, embolization was performed with either a mixture of biologic glue and Lipiodol (n = 16) or Microcoils (n = 2)., Results: The procedure was performed through the femoral artery in 16 patients and through the brachial artery in the remaining two patients. Overall, superselective catheterization and embolization were successfully undertaken in 17 (94.4%) of 18 patients. In the remaining patient, superselective catheterization proved impossible. This patient was treated with an injection of microparticles completed by means of embolization of biologic glue more proximally in an iliolumbar branch. During follow-up (mean, 13.3 months) after embolization, the aneurysm sac shrank in 13 (72.2%) of 18 patients. A new type II endoleak was diagnosed on helical computed tomography or magnetic resonance imaging in two (11.1%) of 18 patients., Conclusion: Percutaneous embolization is a safe and effective technique for treatment of type II endoleaks. However, despite these initially promising results, large long-term follow-up studies will be required to confirm its efficiency.