PROCEDURE:
Percutaneous embolization of type II aortic endoleak
INDICATION:
DATE:
OPERATING PHYSICIAN: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
MEDICATIONS: 1 g IV Ancef, Versed mg IV, Fentanyl mcg IV
CONTRAST: mL Ethiodol
FLUOROSCOPY TIME: minutes
COMPLICATIONS: None immediate
PROCEDURE:
The risks, benefits and alternatives of the procedure as well as conscious sedation were discussed with the_____. After obtaining informed consent the patient was prepped and draped in the usual sterile fashion. A timeout was performed.
The abdominal aortic aneurysm was evaluated with ultrasound and manual palpation. The overlying skin was anesthetized with 1% lidocaine. Under____ guidance an 18 gauge Chiba needle was introduced into the____ . The needle was advanced between the limbs of the aortic endograft at the level of the known endoleak. Pulsatile arterial blood was noted on removal of the obturator. Digital subtraction angiogram was obtained following contrast injection through the needle.
The needle was flushed with D5W and approximately 5 mL of n-butyl cyanoacrylate mixed 1:1 with ethiodol was injected slowly in 2 aliquots into the aneurysm sac under direct fluoroscopy. Needle was pulled back slightly for the second of the two injections. Needle was then pulled back further and final contrast injection was performed.
The patient tolerated the procedure well and left the angiography suite in stable condition without any immediate postprocedural complications.
FINDINGS:
Fluoroscopic images demonstrate percutaneous access of the aneurysm sac from a left anterior approach. The tip of the needle passes between the limbs of the endograft at the L4-5 interspace.
DSA images demonstrate contrast filling a portion of the aneurysm sac at the aortic bifurcation. There is retrograde filling into two right and one left lumbar arteries.
Following injection of glue, there is a cast partially filling the right L4 artery and filling into the aneurysm sac in the same distribution as the previously demonstrated endoleak. Final contrast injection shows lack of filling of the sac and lumbar arteries.
IMPRESSION:
Successful percutaneous embolization of lumbar type II aortic endoleak with NBCA glue.
PLAN:
Patient will return for CTA and clinic appointment with Dr. Doe in 3 months.
Frequently Asked Questions
What is percutaneous embolization of a type II aortic endoleak?
Percutaneous embolization is a minimally invasive procedure used to treat a type II aortic endoleak, which occurs when blood leaks into the sac of an aortic aneurysm from branch vessels. The procedure involves inserting a needle through the skin to inject a substance that blocks the blood flow, preventing further leakage and potential complications.
Indications for percutaneous embolization include the presence of a type II aortic endoleak that is causing symptoms or has the potential to enlarge the aneurysm sac, leading to rupture. It is typically considered when conservative management fails and the risks of the endoleak outweigh the risks of the procedure.
What medications are used during percutaneous embolization of a type II aortic endoleak?
During percutaneous embolization, medications like Ancef (an antibiotic) are used to prevent infection, while Versed and Fentanyl are administered to provide sedation and pain relief. These help ensure the patient's comfort and safety throughout the procedure.
The procedure begins with informed consent, followed by prepping the patient in a sterile environment. Anesthesia is applied to the skin, and a needle is guided into the aneurysm sac using imaging techniques. A glue-like substance is injected to block the blood flow in the leaking vessels. Imaging confirms successful blockage, and the patient is monitored for complications.
What are the potential complications of percutaneous embolization?
While percutaneous embolization is generally safe, potential complications can include infection, bleeding, or non-target embolization, where the embolic material affects unintended areas. However, immediate complications are rare, and patients are monitored closely during and after the procedure to manage any issues that arise.
What follow-up care is required after percutaneous embolization of an aortic endoleak?
After the procedure, follow-up care typically involves a CT angiogram (CTA) to assess the success of the embolization and check for any recurrence of the endoleak. Patients also have a clinic appointment to discuss their recovery and any further treatment needed. This follow-up helps ensure long-term success and health.
What is n-butyl cyanoacrylate, and how is it used in embolization?
N-butyl cyanoacrylate (NBCA) is a medical adhesive used in embolization procedures. It is a liquid glue that quickly solidifies upon contact with blood or tissue, effectively blocking blood flow in the targeted vessels during an endoleak embolization. It's mixed with a radiopaque substance like ethiodol for visibility under imaging.
How effective is percutaneous embolization for type II aortic endoleaks?
Percutaneous embolization is considered an effective treatment for type II aortic endoleaks, with a high success rate in stopping the leak and preventing complications like aneurysm rupture. The use of imaging during the procedure allows for precise delivery of the embolic material, ensuring that the leak is effectively sealed.