The jailed coiling technique: An endovascular solution for saccular aneurysms with suboptimal fixation sites.

ABSTRACT

OBJECTIVE: To evaluate the midterm results of patients with saccular aneurysms treated with the jailed coiling technique. METHODS: A retrospective review of 17 patients treated with the jailed coiling technique over a 7 year period, between 2018 and 2024 at our institution. Treatment entails placing an endograft across the neck of the saccular aneurysm followed by coiling of the aneurysm through an extraluminal catheter. Debranching procedures of the aortic arch were performed when necessary in order to create a sealing zone of >5 mm. Data collected included demographics, anatomical features of the lesions and sealing zones, indication for intervention, method of treatment and technical success, sac expansion, and reinterventions. RESULTS: 17 patients (median age 69, 14 males) were treated for saccular aneurysms with short, suboptimal sealing zones (aortic arch 13, distal thoracic aorta 2, celiac trunk 1, brachiocephalic artery 1). Among the aortic arch aneurysms, six required preoperative debranching procedures of the aortic arch in order to create a short landing zone of 5 mm, making them eligible for the procedure. Technical success was obtained in all patients. One perioperative mortality occurred. Mean follow-up among those treated for arch aneurysms was 32 months (range 1-71 months). One patient who was treated for an aortic arch aneurysm had a persistent endoleak. No sac enlargement was observed. None of the patients required interventions and none experienced aneurysm related mortality. CONCLUSION: The jailed coiling technique is a safe and effective method to treat saccular arterial aneurysms with suboptimal, short sealing zones. It can be utilized for saccular aneurysms located within the aortic arch and for aneurysms located in other locations where coiling or stent grafting is not an option. The procedure can be performed with minimal morbidity with a high percentage of success. Long term durability of the repair needs to be determined.