Clinical significance of type I endoleak on completion angiography

PURPOSE: Type I endoleak is known to be associated with sac enlargement and occasional rupture, therefore, the treatment of type I endoleak is recommended at the time of diagnosis. The aim of this study was to identify the significance of early type I endoleak found on completion angiography. METHODS: Between January 2000 and December 2012, a total of 86 patients underwent endovascular abdominal aortic aneurysm repair (EVAR) and 10 patients (11.6%) were diagnosed with type Ia endoleak on completion angiography. Clinical and radiologic data were reviewed retrospectively. RESULTS: Of the 10 patients, two underwent EVAR with custom-made stent-grafts in the initial stage and both of them needed immediate treatment: one case involved open repair while the other involved insertion of an additional stent-graft. In 8 patients, the amount of leakage decreased after repeated balloon molding. They were managed conservatively and followed up with computed tomography angiography within 2 weeks after EVAR. In 7 of the 8 cases, type Ia endoleaks disappeared. In one patient with a persistent endoleak and a folded posterior wall of the stent-graft, coil embolization was performed 1 week after EVAR. With a median follow-up of 12 months (range, 1-61 months), no patients showed recurrence of type I endoleak or sac expansion. CONCLUSION: Type I endoleaks diagnosed on completion angiography sealed spontaneously in 7 of 10 patients (70.0%). In cases of decreased amounts of leakage after balloon molding, simple observation may be an alternative to repetitive procedures. The long-term follow-up of patients with self-sealed type I endoleaks is mandatory.

Total Laparoscopic Aortobifemoral Bypass

Standard open surgery for aortoiliac occlusive disease has achieved excellent long-term patency, but is accompanied by postoperative morbidity, including ileus, pain and delayed functional recovery. A laparoscopic approach to the aorta may afford several advantages as a less invasive modality. Herein, our two experiences of a total laparoscopic aortobifemoral bypass (LABF) are reported. Two males, 57 and 73-years old, presented with a history of resting pain in both legs (especially right) and progressing severe claudication, respectively. The patients were positioned in right lateral decubitus, with their left side elevated between 70degrees to 80degrees using a pillow and tilted table. Five ports under the pneumoperitoneum were used for the procedure (five ports; 10 to 12 mm). The laparoscopic techniques consisted of aortic dissection, vascular control and intracorporeal anastomosis. The approach to the aorta in the transperitoneal left retrocolic plane was used for the first case, and in the transperitoneal left retrorenal plane for the second. Laparoscopic anastomosis was performed through two continuous running intracorporeal sutures and multiple interrupted sutures. The aortic clamping times were 178 and 185 minutes, respectively. The operative times were 415 and 530 minutes, with liquid diets initiated on the second and third postoperative days, respectively. Both patients suffered minimal postoperative pain, and were subsequently discharged. Total laparoscopic aortobifemoral bypass is more technically demanding than an open procedure. However, our experiences indicate that total laparoscopic aortic surgery is worthy of further development.

Celiac Artery Dissection after Abdominal Blunt Trauma

We report a case of celiac artery dissection after abdominal blunt trauma. A 29-year-old man visited the emergency room for acute left periumbilical pain after abdominal blunt trauma from his child. Computed tomography showed a wedge-shaped splenic infarction with splenic artery thrombus. He was hospitalized for careful observation, and after two days, follow-up computed tomographic angiography showed a progressed celiac artery dissection that involved common hepatic artery and an increased extent of splenic infarction. He underwent conventional angiography, and a self-expandable stent was placed between the celiac axis and the common hepatic artery. After two days, follow-up computed tomographic angiography showed good hepatic arterial blood flow via the stent and no progression of splenic infarction. After ten days, he was discharged without complications.