2896. CT Fluoroscopy-Guided Direct Percutaneous Type II Endoleak Embolization Using n-BCA Glue
Authors* Denotes Presenting Author
Lourens du Pisanie *;
University of North Carolina School of Medicine
Clayton Commander;
University of North Carolina School of Medicine
Hyeon Yu;
University of North Carolina School of Medicine
Charles Burke;
University of North Carolina School of Medicine
Objective:
The most performed type-II endoleak repair methods utilize either transarterial or direct percutaneous sac puncture approaches with CT and/or fluoroscopic guidance. We investigate the technical and clinical feasibility of a novel modified direct percutaneous sac injection (DPSI) technique for treating type II endoleaks using CT fluoroscopic (CTF) guidance.
Materials and Methods:
Data were retrospectively collected from 33 procedures performed on 29 patients (mean age: 77.8 years ± 4.9; male:female ratio = 21:3) with type II endoleaks between August 2019 and June 2022. Technical (intrasac embolic deployment, complications, dose, and procedural time) and clinical (aortic aneurysm size change) parameters were evaluated. The methodology included using intermittent CT fluoroscopy to percutaneously guide a 20 or 21-gauge needle into the excluded aneurysm sac. The position of the needle at the endoleak site was confirmed by imaging and by blood return through the needle. N-butyl cyanoacrylate glue (Histoacryl) and lipiodol were mixed in a 1:4 ratio. The needle, the glue mixture syringe, and a syringe of D5W (5% dextrose in water) are attached to a three-way stopcock. ?The glue mixture is slowly and intermittently injected in small aliquots. The needle is flushed with D5W between glue injections to prevent occlusion of the needle. Intermittent CT fluoroscopy is used to monitor for non-target embolization and appropriate filling of the endoleak channel.
Results:
There was no statistically significant difference in aneurysm sac size (71.9 mm ± 15.3 vs 74.5 mm ± 16.5; p = 0.56). Mean procedure time, sedation time and dose length product (DLP) were 38.5 ± 17.1 minutes, 37.1 ± 14 minutes, and 623.4 ± 334.6 mGy*cm, respectively. Average follow up was 9.2 months ± 5.3. Two complications are reported including nontarget inferior mesenteric artery embolization resulting in bowel ischemia and needle bowel tenting on CT without clinical consequence.
Conclusion:
The CTF-DPSI technique offers lower procedure times and radiation exposure as compared with conventional techniques. It also obviates the need for intersuite transport and a guidewire-catheter system while maintaining intraprocedural embolic observation.
