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Systematic review on transcaval embolization for type II endoleak after endovascular aortic aneurysm repair

Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece. Electronic address: petr.nana7@hotmail.com. Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany. German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany. Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.

Journal of vascular surgery. 2022
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Abstract
INTRODUCTION Persistent endoleak type II (ET II) after endovascular repair for aortic aneurysms is not always a begin condition and has been associated to sac expansion, rupture and re-intervention. A variety of different endovascular approaches are available for ET II treatment. The aim of this systematic review was to assess the currently available literature on transcaval embolization in ET II treatment after standard or complex endovascular aortic aneurysm repair. METHODS This systematic review protocol was registered to the PROSPERO (CRD42021289686). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines and P.I.C.O. model was followed. A data search of the literature was conducted, using PubMed, EMBASE via Ovid and CENTRAL databases, until September 30, 2021. Only studies reporting on ET II embolization using the transcaval approach after endovascular aneurysm repair were included. Studies reporting on different type of endoleak treatment or other embolization approach were excluded. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). Primary outcomes were technical success and freedom from ET II persistence during follow-up while secondary were any post-operative complication associated to transcaval embolization and need for re-intervention. RESULTS The search yielded 2,861 manuscripts in total. Eight manuscripts were included, reporting on 117 patients and 128 transcaval embolizations. The indication for treatment was ET II presence with sac expansion >5mm while in two studies the presence of persistent endoleak has set the indication to intervene. The technical success was 91.4% (117/128) while a variety of embolic materials were used including coils, thrombin, and glue. Three cases of deep vein thrombosis were recorded while the remaining morbidity and mortality were null. Follow-up was ranging between 0-25 months. Out of eight studies, persistent ET II rate was 12.8% and 18 re-interventions were performed (14.1%,); including ten transcaval coil embolizations (56%). Sac expansion was reported in 11 cases out of 3 studies (17%). Only one case of death, not associated to transcaval embolization, was recorded. CONCLUSIONS Transcaval embolization for ET II treatment presents a high technical success and low mortality in the early and mid-term period. The ET II persistence rate is low during the available 12-month follow-up.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine