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Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts
- Source :
- European radiology. 24(6)
- Publication Year :
- 2013
-
Abstract
- To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. • Endoleaks after thoracic endovascular aortic repair are common in 15-30 %. • Most endoleaks can be treated by endovascular means. • Direct percutaneous endoleak repair is described as a bail-out option. • Direct percutaneous aortic arch coil embolisation of type 1a endoleak is possible. • Antibiotic prophylaxis should be administered case by case, considering individual risk factors.
- Subjects :
- Aortic arch
Male
medicine.medical_specialty
Percutaneous
Endoleak
medicine.medical_treatment
Aorta, Thoracic
Marfan Syndrome
Pseudoaneurysm
Blood Vessel Prosthesis Implantation
Aneurysm
medicine.artery
medicine
Thoracic aorta
Humans
Radiology, Nuclear Medicine and imaging
Embolization
Aorta
business.industry
Stent
General Medicine
Middle Aged
medicine.disease
Embolization, Therapeutic
Surgery
Blood Vessel Prosthesis
cardiovascular system
Stents
Radiology
business
Tomography, X-Ray Computed
Aneurysm, False
Subjects
Details
- ISSN :
- 14321084
- Volume :
- 24
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- European radiology
- Accession number :
- edsair.doi.dedup.....2787420c38f40d90732747971e0dab10