San Norberto Enrique M, Fidalgo-Domingos Liliana A, Romero Alejandro, Vaquero Carlos
Division of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
Division of General Surgery, Valladolid University Hospital, Valladolid, Spain.
Vasc Endovascular Surg. 2020 Apr;54(3):278-282. doi: 10.1177/1538574419885271. Epub 2019 Nov 22.
Type II endoleak relates to aneurysm perfusion through a patent branch vessel. Reintervention for type II endoleak should be considered in the presence of significant aneurysm growth. Recurrences and subsequent reinterventions are frequent by occult type II endoleaks through feeder arterial branches. We report a case of a patient with a type II endoleak due to inferior mesenteric artery (IMA) patency associated with aneurysm sac growth after an unsuccessfully attempt of transarterial embolization. Laparoscopic ligation of the IMA with direct sac puncture embolization was performed. The postoperative and 1-year follow-up computed tomography angiography scan demonstrated no endoleak signs and aneurysm sac shrinkage. The proposed modification of this technique constitutes a novel approach to this entity. Total laparoscopic IMA ligation and direct sac puncture embolization technique may increase the success rate for the treatment of endoleaks type II by excluding the recurrences. This technique may offer a safe, feasible, and minimally invasive approach for type II endoleaks when other endovascular techniques are unsuccessful.
Ⅱ型内漏与通过未闭分支血管的动脉瘤灌注有关。在动脉瘤显著增大时，应考虑对Ⅱ型内漏进行再次干预。隐匿性Ⅱ型内漏通过供血动脉分支导致复发和随后的再次干预很常见。我们报告一例患者，在经动脉栓塞尝试失败后，因肠系膜下动脉（IMA）通畅导致Ⅱ型内漏并伴有瘤囊增大。实施了IMA腹腔镜结扎术并直接进行瘤囊穿刺栓塞。术后及1年随访计算机断层扫描血管造影显示无内漏迹象且瘤囊缩小。对该技术的改进建议构成了针对此情况的一种新方法。完全腹腔镜IMA结扎术和直接瘤囊穿刺栓塞技术通过排除复发情况可能会提高Ⅱ型内漏的治疗成功率。当其他血管内技术失败时，该技术可为Ⅱ型内漏提供一种安全、可行且微创的方法。
