Embolization of a type II Endoleak from the Ileo-Lumbar branch of the left hypogastric artery
A 82-year old patient, previously treated with an endoprosthesis to repair an endovascular aneurysm, had to undergo treatment of a type II Endoleak.
In 2014, a CT scan showed an early opacification of the aneurysm because of a revascularization of the sac, as appears in type II Endoleak.
The treatment was decided after a CT scan, performed in September 2015, which showed an increase of the aneurysm sac from 5.7 mm to 6.2 mm.
A super selective BERN-shape Direxion HI-FLO™ with a Fathom™-16 guidewire, was chosen to perform the procedure.
The high flow rate and the high burst pressure of the Direxion microcatheter , provided a clear angiogram which confirmed a type II Endoleak of the aneurysm sac, came from the ileo-lumbar branch of the left hypogastric artery.
The excellent trackability and the torqueablility associated with the bern shape tip, permitted to perform the superselective catheterization and reach the target.
The type II Endoleak embolization was finally achieved using multiple shape coils 0.018“ (Vortx-Diamond and Vortx – Boston Scientific) with a diameter from 3 to 4 mm.
The coils were successfully deployed through the 0.027" (0.69mm) Direxion HiFlow inner lumen.
The final angiography check, the first using the superselective Direxion microcatether and the second using the diagnostic pigtail catheter placed in the aorta, showed an absence of Endoleak with a regular opacification of the aortic-bisiliac lumen.
A CT scan check will be performed within a month.
Study and images courtesy of
Dr. Giuseppe Morelli Coppola - Chief of Radiology Department & Interventional Radiologist – "Pellegrini Hospital" – Napoli
Dr. Francesco Arienzo – Dr. Mauro Maglione - Interventional Radiologists - "Pellegrini Hospital" – Napoli