Endoleak Repair Using Transfemoral Retrograde Embolization Outside the Graft during Endovascular Abdominal Aortic Repair

Background

To preliminarily explore the efficacy and safety of retrograde embolization outside the stent graft via the femoral artery for endoleak repair during endovascular abdominal aortic repair.

Methods

A retrospective analysis was conducted on 13 patients from our center who underwent retrograde endovascular embolization via the femoral artery for endoleak repair during endovascular abdominal aortic repair from December 2021 to March 2024. Nine patients had a type I endoleak, and 4 patients had a type II endoleak. All endoleaks were treated by endovascular coil embolization alone or combined with liquid embolic agents. All patients received regular follow-up with computed tomography angiography postoperatively.

Results

Coil embolization alone was used in 10 patients, coil embolization combined with fibrin glue or thrombin in 2 patients, and fibrin glue embolization alone in 1 patient. Intraoperative angiography revealed complete elimination of the endoleak in 10 patients and significant reduction in 3 patients. During the operation, ectopic embolization of the fibrin glue occurred in 1 patient, with no complications reported in the other patients. During the postoperative follow-up period ranging from 6 to 24 months (10.4 ± 5.4 months), follow-up computed tomography angiography results showed no definite endoleaks and no increase in aneurysm diameter; the aneurysm diameter decreased in 8 patients and did not change in 5 patients. No reoperations or deaths occurred during the follow-up period, resulting in a short-term success rate of 100%.

Conclusion

Retrograde embolization outside the stent graft via the femoral artery can be an alternative method to repair type I or II endoleaks during EVAR, with satisfactory short-term outcomes.