The advent of endoluminal graft repair for abdominal aortic aneurysms has dramatically changed the therapeutic option for many patients. It is now well established that the devices can be safely inserted and short-term results have been excellent. Long-term outcome for many of these patients remains uncertain. The authors present a case report in which incomplete exclusion of the aneurysm with continued endoleak has resulted in aneurysm enlargement. As a result, the patient is not protected from continued expansion and the potential for eventual rupture. It is established in the literature that not all type II endoleaks result in continued expansion of the aneurysm sac. Clearly, however, in this case, documented continued expansion obligates the treating physicians to intervene and either eliminate the endoleak or consider surgical conversion.
The technical difficulties associated with successful obliteration of endoleaks can be substantial. Frequently, the interventionalist is confronted with significant tortuosity, access difficulties, and the potential to cause vascular compromise to an alternative area that may have significant independent complications (i.e., compromise of visceral or mesenteric blood flow).
Wide variability in anatomical and morphologic configuration does not lend itself well to a specific endovascular approach or catheter configuration. The authors describe the use of the Morph catheter (Biocardia, San Francisco, CA). This catheter is dynamically shapeable during the course of the intervention. It allows the operator to achieve access when conventional shaped guides or support catheters may not be adequate. This interesting report clearly highlights the use of this catheter and encourages other interventionalists to at least become familiar with its unique characteristics that may allow improved procedural efficiency and improve overall technical success. |
