Embolotherapy of persistent endoleaks after endovascular repair of abdominal aortic aneurysm with the ancure-endovascular technologies endograft system

PURPOSE: Endoleak is a potential complication after endovascular repair of abdominal aortic aneurysm (AAA), It may result in continued growth of the a neurysm and potentially result in aneurysm rupture, The authors present the ir experience with embolotherapy in patients with persistent perigraft flow treated with the Ancure-Endovascular Technologies endograft system, MATERIALS AND METHODS: Between February 1996 and August 1998, 54 patients u nderwent successful repair of AAA with use of the Ancure system, All underw ent operative angiography and discharge computed tomography (CT), Follow-up included CT at 6, 12, and 24 months, and CT was also performed at 3 months if an endoleak was present on the discharge CT, Persistent endoleak was de fined as perigraft flow still present on the 6-month CT, Seven of 21 initia l endoleaks persisted at 6 months. Six patients returned for embolization o f the perigraft space and outflow vessels including lumbar arteries and the inferior mesenteric artery (IMA). RESULTS: Five of the six patients had leaks from the proximal (n = 1) or di stal attachment sites (n = 4) of the Ancure system with outflow into lumbar arteries and/or the IMA; one leak was caused by retrograde IMA flow, The s ix patients underwent nine embolization procedures with only one minor comp lication. Follow-up CT showed complete resolution of endoleak and decrease in size of the aneurysm sac in all patients. CONCLUSIONS: Although endoleak is commonly seen initially with the Ancure s ystem, persistent leak occurred in 13% of the patients in the study, Persis tent flow in most patients arises from a graft attachment site combined wit h patent outflow vessels such as the IMA or lumbar arteries, Persistent end oleaks can be effectively and safely embolized with use of a combination of coil embolization of the perigraft space and embolization of outflow vesse ls, Such intervention resulted in a decrease in size of the aneurysm sac.