Purpose: To describe the procedural details for primary prevention of type II endoleak with fibrin glue injection into the aneurysm sac at the time of endografting.
Technique: After deployment of the main stent-graft component, the angiographic pigtail catheter is withdrawn, leaving the 0.035-inch standard guidewire between the endograft and the native aorta. Through a brachial-femoral arterial guidewire loop, an 11-cm-long, 6-F introducer is advanced over the wire into the contralateral iliac artery. After deployment of the contralateral iliac extension, a 23-cm, 5-F sheath is advanced over the wire into the aneurysm sac. The wire and vessel dilator are removed, leaving the cannula in the sac. To prevent distal embolization of the sealant, a balloon is inflated in the contralateral limb to secure it to the native vessel before 5 mL of fibrin sealant are injected into the sac via a double-syringe delivery system inserted through the sheath. The balloon is left in place for 1 minute after sealant injection. In 64 consecutive patients in whom this technique has been used, sac embolization has been successful. There have been no intraoperative complications or in-hospital mortality. Over a mean follow-up of 9.3+/-4.4 months (range 1-18), only 1 lumbar endoleak has been detected on surveillance imaging.
Conclusions: This preventive strategy appears to be an effective approach and the best therapeutic choice for preventive management of type II endoleak.