Mechanism of failure in the treatment of XXXX with percutaneous coil embolization.

@entity1 @entity449 @entity1070 @entity254 @entity439 @entity1317 @entity1028 @entity2849
PURPOSE: @entity1070 after @entity1028 repair is a failure of @entity439 sac exclusion with unknown long-term consequences. Elevated @entity439 sac pressures documented in these @entity1 have led us to aggressively treat @entity1070 with percutaneous transluminal coil embolization (PTCE). The purpose of this study was to evaluate the results and the mechanisms of failure of PTCE for @entity1070 . METHODS: One hundred ninety-one @entity1 underwent endograft repair of @entity449 . Twenty-three of 28 @entity1 with persistent primary (>3 months) or secondary (new-onset) endoleak underwent angiography; 14 of these @entity1 had @entity1070 . We reviewed our endovascular registry data, hospital charts, and radiologic studies of @entity1 with @entity1070 and analyzed the results in those treated with PTCE of the inflow vessel. RESULTS: All 14 @entity1 with @entity1070 were @entity1 , with a mean age of 76.7 years and a mean preoperative maximal @entity439 diameter of 5.7 +/- 1.0 cm. The @entity1070 was primary in 12 @entity1 (86%) and secondary in two @entity1 (14%) and iliolumbar in 11 @entity1 (78%) and mesenteric in three @entity1 (21%). Although a dominant affluent collateral channel (inosculation) was apparent in eight @entity1 (57%), six @entity1 (43%) showed a network of collateral vessels (retiform @entity254 ). In six @entity1 (43%), angiography revealed a second or "outflow" vessel indicative of a complex endoleak. In four @entity1 with retiform iliolumbar @entity1070 , PTCE was not attempted because of the retiform nature of the endoleak. The remaining 10 @entity1 underwent PTCE, with coil deployment in all 10 and apparent initial technical success in nine @entity1 . Follow-up computed tomographic scans revealed persistent @entity1070 in six @entity1 (60%). Mechanisms of failure included persistent flow through the coils in the treated vessel in two @entity1 , development of a retiform @entity254 around the coiled vessel in three @entity1 , and development of a new @entity1070 after successful occlusion of an iliolumbar endoleak in one @entity1 . Two @entity1 underwent repeat PTCE with successful @entity439 sac exclusion in one. @entity1317 complicated one of the 12 PTCEs, and the resulting @entity2849 was successfully treated with PTCE. Angiographic visualization of an outflow vessel (complex endoleak) was associated with PTCE failure (P =.008). CONCLUSION: PTCE of @entity1070 has a high failure rate because of multiple anatomic mechanisms.
