Type 2 endoleak embolization and utilization of non-contrast-enhanced magnetic resonance angiography (NCE-MRA) as a non-invasive imaging follow-up method.
Abstract
Endovascular aneurysm repair (EVAR) is a minimally invasive technique widely used in abdominal aortic aneurysm treatment. The most common complications after EVAR remain endoleaks, type 2 endoleak (T2EL) being the most prevalent. T2EL detection and surveillance require imaging techniques such as computed tomography angiography (CTA), contrast-enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound, or digital subtraction angiography (DSA). However, these modalities are associated with numerous limitations, including exposure to ionizing radiation, contrast media administration, or operator dependency, as in the case of ultrasonography. A non-contrast-enhanced MRA could be a substitute non-invasive method for endoleak monitoring. Our case report describes an 83-year-old female patient with type 2 endoleak and enlarging aneurysm sac detected on a CT scan. Despite the enormous aneurysm size, the patient underwent endovascular treatment owing to multiple comorbidities. Due to challenging feeding vessel anatomy, catheterization of the aneurysmal sac was impossible. Attempted polymerization of the aneurysmal sac with Glubran-2 partially sealed the sac and obliterated the feeders' inflow. Unfortunately, a non-targeted embolization resulted in the loss of patency of the right feeder and adjacent communicating branch. The patient underwent follow-up imaging that included non-contrast-enhanced as well as contrast-enhanced MRA. The examination revealed the presence of a small residual endoleak, a freshly formed thrombus, and areas of old thrombi. The NCE-MR appeared to be a valuable tool in endoleak detection and provided a detailed clot morphology.
Keywords: EVARendoleakstent graftmagnetic resonance angiography
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