SCOTTSDALE, ARIZ. — Type II endoleaks after endovascular aneurysm repair were prevented by using fibrin glue in all but 2 of 84 consecutive patients, Dr. Mauro Zanchetta said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.
The patients were treated over a 2-year period, up to December 2005, with a mean follow-up period of 14 months, at which time 76 of the patients had no complications, he said. The complications that did occur were not due to the fibrin glue, which induces thrombosis of the side branch vessels. There were graft-deployment problems in two patients, implantation problems in two patients, and systemic complications in three patients. One patient died during the procedure.
In all patients without endoleak, subsequent examinations showed sustained aneurysm shrinkage. The fibrin glue treatment is “easy, effective, and durable,” said Dr. Zanchetta of the Ospedale di Cittadella in Padua, Italy. “This approach reveals a new strategy for routine prevention of type II endoleaks.” He said the bifurcated grafts were deployed from a right femoral access. The fibrin sealant (5 mL) was injected directly into the aneurysm sac using a double-syringe delivery system inserted through a 23-cm, 5-F sheath, and advanced from a left access over a guidewire that remained in place after angiography between the aorta and the graft. A balloon was inflated in the left limb of the stent graft to prevent the sealant from leaking and causing distal embolization. It was left in place for 1 minute after injection. Intraoperative angiography and color Doppler ultrasound showed the majority of the patent side branches found and treated were peripheral lumbar arteries, with a range of one to three per patient. Ten patients also had patent inferior mesenteric arteries treated.