Transarterial Embolisation of Abdominal Aortic Type II Endoleaks Accessed via the Deep Circumflex Iliac Artery: A Case Series and Literature Review.

We report our technique and experience treating 3 patients with native abdominal aortic aneurysm (AAA) sac expansion following EVAR, who were managed with transarterial embolisation via the deep circumflex iliac artery (DCIA). In this case series, we demonstrate that transarterial embolisation via the DCIA is a feasible and safe treatment option. The DCIA should be routinely interrogated with angiography as not only a cause of possible Type II endoleak, but also to identify a potential access route to the abdominal aortic sac for interventional treatment.

Surgeons versus radiologists: do we care what they think?

BACKGROUNDS: Acute surgical care nowadays usually involves access to urgent imaging. There is a paucity of data on how often the images or radiologist reports of these images are used by the surgical team. We aimed to identify the rates and timeliness of radiology images and report viewing for acute surgical admissions in an Australian tertiary university teaching hospital. METHODS: We utilized a data set comprising radiological studies completed at our institute during a one-month period. Investigations were classified by modality and whether images or reports were available 'in-hours' or 'after-hours'. The time taken from imaging to reports available for viewing by the surgical team was calculated using timestamps derived from electronic hospital systems. Spearman's rho test was used to assess correlation between the Study Ascribable Time and time to view an image or report. RESULTS: Of 40 042 investigations, 1156 (3%) satisfied study criteria. Both images and reports were viewed in 82% (n = 950/1156) of cases. CT scans had the shortest median time for image (14 min, IQR 4-47 min) and report (25 min, IQR 8-68 min) viewing. CT (95%, n = 410/430) and MRI (95%, n = 38/40) scans had the highest proportion of both images and reports viewed, regardless of whether the scan was completed 'in-hours' or 'after-hours'. X-ray reports were viewed least often (73%). CONCLUSION: This study demonstrates a high level of viewing of acute surgical radiological imaging and reports by surgical teams. The 'simpler' the study the less likely the radiology report will be viewed.

Complicated embolisation of late endoleak via direct sac puncture: not all endoleaks are a type II endoleak.

BACKGROUND: Endoleaks after endovascular aortic aneurysm repair (EVAR) occur frequently with type 2 being the most common. Treatment of type 2 endoleaks is indicated if the aneurysmal sac increases in size. CASE REPORT: In this case report, we will discuss a patient who presented with aneurysmal sac size increase 11 years after undergoing EVAR for an asymptomatic abdominal aortic aneurysm which extended into the iliac arteries. Multi-phase CT demonstrated an endoleak with features commonly seen in type 2 endoleaks; pooling of contrast near a lumbar artery orifice on the angiographic phase which increases during the delayed phase. Both internal iliac arteries were sacrificed during the initial EVAR. Percutaneous direct sac puncture was therefor performed and angiogram during the procedure revealed no feeding or draining lumbar arteries. During attempts to embolize the perfused part of the aneurysmal sac non-target embolization into the main body of the graft occurred and the presence of type 3b endoleak was confirmed. The non-target embolization did not result in permanent sequelae. CONCLUSIONS: Type 3b endoleaks are rare and can mimic type 2 endoleaks, which can cause serious complications if not identified properly. Rapid increase in aneurysmal sac size is uncommonly seen in type 2 endoleaks and if present needs to trigger further diagnostic investigations.