Hunting the Nidus—A Case Series of Onyx-Led Treatment of Type II Endoleak

Case Presentation: CASE 1: A 71-year-old female experienced sac expansion in post-EVAR follow-up. In October 2022, CTA showed significant increase in aneurysmal sac and type II endoleak originating from the L3 lumbar artery causing the sac expansion. Following multidisciplinary team meeting, embolization of type II endoleak was decided. Right arterial access was achieved followed by right iliolumbar artery cannulation. A microcatheter was inserted into the nidus, and Onyx was injected to induce thrombosis. 28 mL of onyx was injected to achieve reflux ensuring complete occlusion. CASE 2: 81-year-old male who had undergone EVAR in 2017, experienced sac expansion in post-EVAR follow-up. A sudden increase in aneurysmal sac size was noted in 2022 along with type II endoleak arising from L4 and small IMA. Follow-up scan by March 2023 confirmed further increase in size of sac. Left CFA access was achieved via 6Fr sheath. Left iliolumbar artery was successfully cannulated and a micro-catheter advanced into the aneurysmal sac via left lumbar artery. 9.5 mL of 34L Onyx was injected with satisfactory filling of the nidus and several lumbar arteries.

Conclusion: In both cases, full occlusion of the endoleak was successfully accomplished using the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx), signifying technical success through comprehensive embolization of the nidus and its collateral vessels.

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Artikel online veröffentlicht:
02. April 2024