Advanced Imaging Techniques in the Treatment of Type II Endoleaks

Purpose: This educational presentation demonstrates the utility of augmented fluoroscopic guidance in facilitating effective embolotherapy for type II endoleaks.

Materials and Methods: This is an annotated, image-rich review of real-world cases from a single institution. The relevant anatomy, pathophysiology, and classification of type II endoleaks will be discussed. Common indications for treatment will be outlined as well. The presented cases will include a variety of technical approaches to type II endoleak embolization, including transarterial, translumbar, and transcaval. Together these cases will also highlight progressively sophisticated applications of fluoroscopic needle-guidance technology in these procedures. The basic technique for generating live fluoroscopic overlay will be included.

Results: Fluoroscopic needle-guidance software has continued to improve in its accuracy and accessibility. At our institution we have found the practical applications of this technology to be myriad. Although no formal analysis of our cases has yet been performed, it stands to reason that fewer needle passes, shorter procedure times, and lower radiation exposure are all potential benefits of employing needle-guidance overlay in certain fluoroscopy-guided procedures.

Conclusions: The endovascular repair of type II endoleaks can be accomplished from several approaches. It is our hope that this review will adequately demonstrate how live fluoroscopic needle guidance may aid other operators in the planning and treatment of type II endoleaks when such treatment is warranted. It is conceivable that the enhanced accuracy afforded by this technology could serve to shorten procedure times and limit complications.