Embolization of type II endoleaks fed by the inferior mesenteric artery: Using the superior mesenteric artery approach

Purpose: To evaluate the use of a superior mesenteric artery (SMA) approach to embolize type II endoleaks arising from the inferior mesentericartery ( IMA). Technique: When reperfusion of the aneurysmal sac via the SMA occurs throug h the IMA, as shown by computed tomography (CT) and angiography, the IMA or igin can be accessed via the marginal artery or the anastomosis of Riolan. The SMA is catheterized with a 5-F catheter, and a coaxial catheter is adva nced to the leak to deliver 2- to 8-mm-diameter minicoils to embolize the I MA origin and entire aneurysmal sac. Embolization usually requires from 1 t o 2 hours to complete. in our experience with this technique in 11 cases, c omplications have not occurred, and there has been only one very small resi dual leak that sealed the next day. Over a 24.5-month follow-up (range 12-3 9), the endoleaks have remained sealed according to serial color duplex sca ns. Conclusions: Successful percutaneous treatment of type II endoleak due to I MA inflow can be accomplished using an SMA access via the Riolan anastomosi s or marginal artery. The procedure appears to be safe and has no adverse e ffects.