Academic Journal
Videolaparoscopic-Guided Saccography and Direct Sac Embolization After Standard EVAR.
| Τίτλος: | Videolaparoscopic-Guided Saccography and Direct Sac Embolization After Standard EVAR. |
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| Συγγραφείς: | Mezzetto L; Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy., Grosso L; Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy., D'Oria M; Vascular and Endovascular Surgery Unit, Cardiovascular Department, University Hospital of Cattinara, Trieste, Italy., Weindelmayer J; General and Upper Gastrointestinal Surgery, Integrated University Hospital of Verona, Verona, Italy., Giacopuzzi S; General and Upper Gastrointestinal Surgery, Integrated University Hospital of Verona, Verona, Italy., De Manzoni G; General and Upper Gastrointestinal Surgery, Integrated University Hospital of Verona, Verona, Italy., Veraldi GF; Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy. |
| Πηγή: | Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2026 Aug; Vol. 33 (4), pp. 1931-1938. Date of Electronic Publication: 2025 Feb 26. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Sage Publications Country of Publication: United States NLM ID: 100896915 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-1550 (Electronic) Linking ISSN: 15266028 NLM ISO Abbreviation: J Endovasc Ther Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2015- : Thousand Oaks, CA : Sage Publications Original Publication: Phoenix, AZ : The Society, c2000- |
| Ιατρικοί όροι (MeSH): | Endoleak*/diagnostic imaging , Endoleak*/therapy , Endoleak*/etiology , Endovascular Aneurysm Repair*/adverse effects , Embolization, Therapeutic*/adverse effects , Laparoscopy*/adverse effects , Aortic Aneurysm, Abdominal*/surgery , Aortic Aneurysm, Abdominal*/diagnostic imaging , Aortography*, Humans ; Treatment Outcome ; Time Factors ; Retrospective Studies ; Predictive Value of Tests ; Registries ; Aged, 80 and over ; Aged ; Female ; Male ; Risk Factors |
| Περίληψη: | Introduction: The occurrence of type II endoleak (T2EL) presents a significant challenge in standard endovascular aneurysm repair (EVAR), with ongoing debate in the literature regarding its optimal management. Although spontaneous resolution has been observed in many cases, intervention is often required to prevent progressive sac enlargement and rupture. Various approaches have been described, including translumbar, transarterial, and transcaval embolization, as well as direct sac puncture. The aim of this study is to evaluate the role of videolaparoscopic-guided saccography and direct sac embolization (ViSE) in patients with sac enlargement following EVAR. Methods: A prospectively maintained registry of patients undergoing standard EVAR between 2016 and 2022 at our institution was retrospectively reviewed. Exclusion criteria included concomitant computed tomography (CT)-diagnosed type I endoleak or type III endoleak (T1EL or T3EL), less than 6 months of follow-up, or no available imaging study for review. A nidus posterior to the main body of endograft and a hostile abdomen (severe obesity body mass index [BMI] >35 kg/m2, previous open surgery, or history of peritonitis) were considered contraindications to ViSE. Results: A total of 259 standard EVAR procedures were performed during the study period, with 63 patients (24.3%) identified as having T2EL, 26 underwent endovascular treatment for significant sac growth during follow-up; 14 of these patients received ViSE (5.4%) and were included in the study. The median procedure time and median fluoroscopic time were 140 (interquartile range [IQR]=105-150) and 40.5 (IQR=31-45) minutes, respectively. Technical success was achieved in 12 of 14 patients (87%). In 7 patients (50%), the inferior mesenteric artery (IMA) was ligated. An occult T1EL or T3EL endoleak was revealed in 5 patients (35%), requiring an immediate or staged adjunct procedure. After a median follow-up of 32.4 months (IQR=25.3-51.7), 2 patients presented sac growth and required surgical conversion. None of the patients died due to aortic-related causes. Conclusion: Videolaparoscopic-guided saccography and direct sac embolization may be considered a valid alternative in patients with T2EL and sac growth. In our early experience, it has proven to be safe and effective in treating the nidus and IMA, and identifying hidden T1EL or T3EL.Clinical ImpactVideolaparoscopic-guided saccography and direct sac embolization (ViSE) represent a valuable option for managing type II endoleak (T2EL) with sac enlargement after EVAR. This approach allows precise treatment of the nidus and the inferior mesenteric artery while also identifying undetected type I and III endoleaks that may require further intervention. By integrating ViSE into clinical practice, physicians can improve diagnostic accuracy and expand treatment strategies for complex endoleak cases. The technique enhances endovascular options, potentially reducing the need for open conversion and improving long-term outcomes in patients with persistent sac growth. |
| Competing Interests: | Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Contributed Indexing: | Keywords: EVAR; endoleak; laparoscopic-guided saccography; sac embolization |
| Entry Date(s): | Date Created: 20250227 Date Completed: 20260716 Latest Revision: 20260716 |
| Update Code: | 20260717 |
| DOI: | 10.1177/15266028251320805 |
| PMID: | 40012302 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1545-1550 |
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| DOI: | 10.1177/15266028251320805 |