The Perigraft Approach for Type II Endoleak Embolization

Sunday, March 5, 2023

3:27 PM – 3:36 PM

Location: Phoenix Convention Center, 222C

Presenting Author(s)

Henry Szeto, DO

Interventional Radiology Resident
Christiana Care

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Assaf Graif, MD (he/him/his)

Attending Physician
Christiana Care
AP

Ankit M. Patel, MD

Attending Physician
Pinnacle Interventional and Physicians, Inc.
Ansar Z. Vance, MD (he/him/his)

Attending Physician
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Shawdon Molavi, MD (he/him/his)

Interventional Radiology Independent Resident
Christiana Care
CG

Christopher J. Grilli, DO

Attending Physician
Christiana Care
GK

George Kimbiris, MD, FSIR

Attending Physician
Christiana Care
Daniel A. Leung, MD, FSIR

Professor, Program Director
Christiana Care Health Services

Disclosure(s):

Henry Szeto, DO: No financial relationships to disclose

Assaf Graif, MD: Boston Scientific, Inc.: Advisory Committee or Review Panel Member (Ongoing)

Ansar Z. Vance, MD: No relevant disclosure to display

Shawdon Molavi, MD: No financial relationships to disclose

Daniel A. Leung, MD, FSIR: Boston Scientific: Consultant (Ongoing), Speaking and Teaching (Ongoing); Cook: Speaking and Teaching (Ongoing)

Purpose: Effective management of type II endoleaks requires technical proficiency in multiple catheterization techniques depending on the supply and complexity of the endoleak. While the most commonly used access routes remain the transarterial and translumbar approaches, novel approaches such as transcaval access are increasingly being used in cases where the traditional techniques are unsuccessful or inadequate. The perigraft approach is an alternative novel option for endoleak embolization, which involves catheterization of the aneurysm sac between the common iliac artery and endograft. Our study aims to determine safety and effectiveness of the perigraft technique for embolization of type II endoleaks.

Materials and Methods:

Single-center retrospective review from 2014 - 2020 of 24 consecutive patients (12.5% female, mean age of 80.1 ± 6.4 years) who underwent 28 type II endoleak embolization procedures via a perigraft approach. Endpoints included technical success of perigraft catheterization, technical success of endoleak embolization, reintervention, freedom from AAA growth at follow-up, and adverse events.

Results: Technical success of perigraft catheterization and endoleak embolization were 92.9% and 89.3%, respectively. A combined transarterial and perigraft approach was employed in 30.8% (n=8/26). Ethylene vinyl alcohol copolymer (Onyx) and coils were used in 92.9% and 46.4% cases, respectively. Freedom from AAA growth occurred in 85% (n=17/20). Reintervention occurred in 20.8% (n=5), including 4 repeat perigraft catheterizations. There were 2 SIR minor adverse events including a groin hematoma and dyspnea in a COPD patient. One major adverse event not related to the procedure was recorded involving an admission for atrial fibrillation and urinary retention. During follow up, 1 patient suffered AAA rupture 20 months after the successful index procedure requiring proximal snorkel extension and endograft relining. The 30-day mortality rate was 0. No type Ib endoleaks developed as a result of perigraft catheterization.

Conclusion: The perigraft approach is safe and effective catheterization technique for embolization of type II endoleaks and can replace the translumbar and transcaval approaches in many cases with the advantage of not requiring sac puncture. Like the transcaval approach, it can be performed in a supine patient from a transfemoral approach and can be combined with other approaches if required. The perigraft approach is a useful addition to the armamentarium of catheterization techniques of type II endoleaks.