Transradial Repair of Type IA Endoleak

J INVASIVE CARDIOL 2019;31(11):E331-E332.

Key words: abdominal aortic aneurysm, endoleak repair, transradial approach, type IA endoleak

An 81-year-old Caucasian male with a history of hypertension and a known abdominal aortic aneurysm (AAA) was referred to the endovascular clinic for a rapidly expanding 6 x 5.5 cm AAA (Figure 1A). He was scheduled for an elective endovascular aneurysm repair, undertaken successfully with insertion of a 22 x 14 x 13 mm main body and a 16 x 14 mm limb-extension Gore Excluder AAA endoprosthesis (W. L. Gore & Associates) (Figures 1B-1D). Dual-antiplatelet therapy was recommended for at least 6 months with close surveillance and follow-up with the endovascular service.

Surveillance CT angiography at 1 month showed endoleak with presence of contrast within the aneurysmal sac (Figure 2A). Detailed review of the imaging revealed a type IA leak (Figure 2B) in addition to 2 other type II endoleaks from the inferior mesenteric artery (Figure 2C) and lumbar artery (Figure 2D). Due to high risk of complications and potential for rupture related to the type IA leak, an elective repair was performed. Right radial access was obtained with a 6 Fr sheath. A multipurpose 6 Fr guide catheter was used from the right radial artery, allowing for a craniocaudal approach providing adequate support for the deployment of 26 Interlock coils (Boston Scientific) (Figures 3A-3C) for repair and resolution of type IA leak (Figure 3D). The type II leaks were managed expectantly, based on their low-risk features. The patient was discharged 3 hours post procedure.

Postrepair surveillance imaging at 1 year continued to show complete resolution of endoleak (Figures 4A-4D) and stabilization of aneurysmal sac size. For this patient, craniocaudal approach via radial access and the multipurpose curve provided ease of selective cannulation of type I endoleak and solid support to deliver multiple coils.

From the ¹AU/UGA Medical Partnership, Athens, Georgia; and ²the Department of Interventional Cardiology & Endovascular Medicine, Deborah Heart and Lung Center, Browns Mills, New Jersey.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted February 22, 2019.

Address for correspondence: Kintur Sanghvi, MD, FACC, FACAI, Associate Director of Interventional Cardiology & Endovascular Medicine, Deborah Heart and Lung Center, 200 Trenton Road, Browns Mills NJ 08054. Email: sanghvik@deborah.org