Endovascular aneurysm repair (EVAR) has been linked to the formation of type II endoleaks. The transarterial iliolumbar approach to repair this complication is occasionally difficult and associated with a lower technical success rate due to the anatomical features of the area.
However, earlier this year Dr. Yunosuke Nishihara of Saga-Ken Medical Centre Koseikan in Saga, Japan, discussed two cases in which the SwiftNINJA® Steerable Microcatheter successfully embolized type II endoleaks using the iliolumbar artery approach after attempts employing other microcatheters and conventional catheterization techniques had failed.
Case 1: A 68-year-old female patient
- EVAR was performed in January 2014, immediately followed by a persistent type II endoleak and increased diameter of the aneurysm.
- Transfemoral transarterial embolization was attempted in March 2015 but failed because selection of the iliolumbar artery and beyond was not possible.
- At follow up, the aneurysm size was 15 mm greater than the previous year. Transarterial iliolumbar embolization using the SwiftNINJA was performed in March 2016.
- The SwiftNINJA was articulated to cannulate a strong angle bifurcation. Locking and unlocking the tip of the SwiftNINJA at an angle along the bifurcation allowed for easy vessel selection and advancing of the guidewire.
- After exchanging the catheter, the tip of the selective microcatheter was guided into the aneurysm sac; the endoleak cavity and feeding artery were embolized.
- After embolization, no blood flow into the endoleak cavity was observed.
Case 2: A 78-year-old male patient
- EVAR was performed in January 2014, immediately followed by a persistent type II endoleak.
- The aneurysm size was 8 mm greater than the previous year and the patient was admitted in March 2016 to undergo embolization via the transarterial iliolumbar approach using the SwiftNINJA.
- The SwiftNINJA was the primary microcatheter used to cannulate the aneurysm and was guided to the bifurcation without a guidewire.
- A guidewire was then successfully placed into the aneurysms feeding vessel and the SwiftNINJA was introduced successfully.
- After exchanging the catheter, the tip of the selective microcatheter was guided into the endoleak cavity.
- The endoleak cavity was embolized and coil embolization was performed successfully on suspected feeding and/or outflow vessels.
Despite the complexities surrounding the transarterial iliolumbar approach, the author noted that the SwiftNINJA improved the selectivity of target vessels and provided enough support for guidewire introduction into acute bifurcating vessels to not allow catheter kickback. These device advantages can lead to other patient and clinician benefits.
SwiftNINJA® Steerable Microcatheter
Merit Medical’s SwiftNINJA® Steerable Microcatheter is the single most advanced and only 180-degree articulating microcatheter on the market. Able to navigate difficult vasculature, the SwiftNINJA offers unparalleled performance by utilizing three main advantages: speed, control, and delivery.
To learn more about the SwiftNINJA, please click here:
Nishihara, Y. (2017). Embolization of post-EVAR type II endoleaks using SwiftNINJA® [White paper]. Sumitomo Bakelite Co., LTD., Tokyo, Japan: Medical Products Business Division.
Dr. Yunosuke Nishihara received payment from Sumitomo Bakelite Co., Ltd. for the performance of this study.