• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

Laparoscopic Approch to Repair a Type II Endoleak From the Median Sacral Vessel

Diana Losada, MD, FRCSC, Francois Julien, MD, FRCSC, Joseph Mamazza, MDCM, FRCSC, Jean Denis Yelle, MD, FRCSC, FACS. Minimally Invasive Surgery, Division of General Surgery, The Ottawa Hospital, University of Ottawa.

INTRODUCTION: An endoleak is a persistent blood flow in the aneurysm sac extrinsic to the endograft. It is the most common complication after endovascular aneurysm repair (EVAR), reported to occur in 10% to 30% of patients. Type II endoleak results from collateral retrograde flow usually from the lumbar arteries, inferior mesenteric artery, or median sacral artery. In general, they are thought to be clinically benign and treatment is reserved for endoleaks associated with enlargement of the aneurysm sac.

We report a case of a 80-year-old patient who had a persistent Type II endoleak after endovascular repair of an abdominal aortic aneurysm (AAA). The endoleak was repaired with laparoscopy ligation of the median sacral artery. 

CASE REPORT: An 80-year-old male patient underwent an uneventful endovascular repair of 5.9 cm infrarenal abdominal aortic aneurysm in September 2009. Routine CT scan in 2012 revealed a type II endoleak and the aneurysm sac enlarged at 6.6 cm. An angiogram identified an Endoleak that appeared to be fed by retrograde flow in the median sacral artery with outflow to the L5 lumbar branches (Fig. 1). Unfortunately, embolization was not feasible.


Fig. 1 The endoleak was visualized, the main arterial supply is retrograde flow within the median sacral artery.

The patient was taken to the operating room for a laparoscopic ligation of the median sacral artery. The camera was placed in the umbilicus using an open technique. Two others ports 12mm and 5mm were placed in the right side and one 5mm in the left side. The patient was placed in steep Trendelenburg. The rectosigmoid was then pulled out of the pelvis. The right limb of the graft was identified, it was large and thrombosed. The space between the aortic bifurcation was dissected with the hook electrocautery to expose the sacral promontory. The left femoral vein was identified. The median sacral artery was found and double clipped (Fig. 2). There were no intraoperative or post-operative complications.


Fig. 2 Laparoscopic ligation of the median sacral vessel.

DISCUSSION: Repair of Type II endoleaks can be accomplished by endovascular or open surgical techniques. Laparoscopic repair of endoleaks may offer another useful method in the treatment of refractory endoleaks. Richardson et al. were successful in two patients using laparoscopic ligation to stop back bleeding from the inferior mesenteric artery in expanding aneurysms after EVAR with low morbidity and no mortality. Our case is the first reported case of a laparoscopic ligation of middle sacral artery done to repair a type II endoleak. Few studies described a technique of laparoscopic ligation of the median sacral artery before the resection of a sacrococcygeal teratoma.

In summary, the laparoscopy ligation offers a viable alternative in the management of select persistent type II endoleaks following endovascular aneurysm repair.

View Poster

423

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons