Triaxial system for embolization of type II endoleak after endovascular aneurysm repair.

Purpose: To demonstrate the utility of a triaxial catheter system for embolization of type II endoleak after endovascular aneurysm repair.

Technique: The technique is illustrated in 2 patients with sac enlargement owing to persistent type II endoleak of lumbar artery origin. In both cases, the access to the iliolumbar and lumbar arteries was very long and tortuous. For selective catheterization in this situation, a 4-F catheter is advanced through the access site, and 2.7-F microcatheter is inserted into the iliolumbar artery, followed by a 1.9-F untapered microcatheter. The latter is advanced along with a 0.014-inch microguidewire into the feeding artery. Supported by the 2.7-F microcatheter, the no-taper microcatheter is then navigated through the endoleak to the draining vessel for embolization.

Conclusion: This simple-to-use triaxial catheter system seems well suited for superselective embolization of type II endoleaks with very long and tortuous access routes. If glue is used and multiple doses are required, access to the feeding artery is not lost if the smaller microcatheter has to be replaced.