Onyx Embolization of an Acute Type II Endoleak Causing Recurrent Hemorrhage Post Emergency Endovascular Aortic Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

Abstract

The authors report a case of ongoing retroperitoneal hemorrhage from a ruptured abdominal aortic aneurysm (AAA) following treatment by endovascular abdominal aortic aneurysm repair (EVAR). Unusually, the continued hemorrhage was secondary to a lumbar type II endoleak. This was successfully embolized with onyx. Only one other similar case has been reported.

Keywords

abdominal aortic aneurysm - acute type ii endoleak - endovascular repair

• References

• 1 Karthikesalingam A, Holt PJ, Vidal-Diez A. et al. Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Lancet 2014; 383 9921 963-969
• 2 Powell JT, Sweeting MJ, Thompson MM. et al; IMPROVE Trial Investigators. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014; 348: f7661
• 3 Grieve R, Gomes M, Sweeting MJ. et al; IMPROVE Trial Investigators. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial. Eur Heart J 2015; 36 (31) 2061-2069
• 4 Brown A, Saggu GK, Bown MJ, Sayers RD, Sidloff DA. Type II endoleaks: challenges and solutions. Vasc Health Risk Manag 2016; 12: 53-63
• 5 Kaczynski J, Jaber B, Woolgar J. Rupture of the infrarenal abdominal aortic aneurysm (AAA) following an endovascular aneurysm repair (EVAR) due to an isolated type II endoleak. BMJ Case Rep 2014; 2014 (14) bcr2013202964
• 6 Chan KK, Siu WT, Fung KH, Yau KK, Wong SK, Li MK. Acute symptomatic abdominal aortic aneurysm secondary to endovascular stent graft associated type II endoleak. Asian J Surg 2006; 29 (03) 157-160
• 7 Khaja MS, Park AW, Swee W. et al. Treatment of type II endoleak using onyx with long-term imaging follow-up. Cardiovasc Intervent Radiol 2014; 37 (03) 613-622
• 8 Saqib NU, Charlton-Ouw KM, Azizzadeh A. Managing type II endoleaks. Endovasc Today 2013; 45-50
• 9 Chung R, Morgan RA. Type 2 endoleaks post-EVAR: current evidence for rupture risk, intervention and outcomes of treatment. Cardiovasc Intervent Radiol 2015; 38 (03) 507-522
• 10 Hartung O, Vidal V, Marani I, Saran A, Bartoli JM, Alimi YS. Treatment of an early type II endoleak causing hemorrhage after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. J Vasc Surg 2007; 45 (05) 1062-1065