Laparoscopic lumbar artery ligation for the treatment of Type II Endoleak after endovascular aneurysm repair (EVAR)

Saseem Poudel, MD, Dai Miyazaki, MD, Yuma Ebihara, MD, PhD, Suguru Kubota, MD, PhD, Yo Kurashima, MD, PhD, Satoshi Hirano, MD, PhD, Yosihiro Matsui, MD, PhD. Department of Gastroenterological Surgery II, Department of Cardiovascular and Thoracic surgery, Hokkaido University.

 

Introduction: Endovascular aneurysm repair (EVAR) has spread widely as low invasive treatment for abdominal aneurysm (AAA) in recent years. Type II endoleak is one of the most common complication and is found in about 10% of the patients after 1 year of the surgery. Increase in aortic diameter is often considered an indication for intervention. In Japan, most of the centers opt for Transarterial embolization (TAE) as first choice treatment option. It is however technically challenging and has a high relapse rate of around 80%. Our center has recently started using laparoscopic lumbar artery ligation surgery for persistent type II endoleak after EVAR and is the first center to report this technique in Japan.

 

Objective: To access the feasibility and safety of laparoscopic lumber artery ligation for type II endoleak after EVAR from our initial experience.

Method: The surgery is done using 1 port on umbellicus and 3 ports on left side of the patient. Left side of the aorta is exposed by sharp dissection of the mesenteric adhesions. Vertebrae and aorta is exposed by resection of sigmoid colon mesentery. Dorsal surface of aorta is dissected until the right border of Inferior venacava. Lumber arteries feeding the aortic aneurysm is identified and ligated using laparoscopic clips and resected. Intraoperative aortography is done to confirm that the leak has disappeared.

Result: So far we have done two cases with this method.
Case 1: 79 year old male.
Time from the first surgery: 3 years 3 months.
Surgery performed: Laparoscopic lumber artery ligation
Operation time: 2 hours 41 mins
Operative blood loss: negligible
The patient was discharged on 4th post-operative day and is being followed up in outpatient department for 9 months without relapse.
Case 2: 81 year old male
Time from the first surgery: 2 years 10 months.
Surgery performed: Laparoscopic lumber artery and inferior mesenteric artery ligation
Operation time: 2 hours 30 mins
Operative blood loss: negligible
The patient was discharged on 6th post-operative day and is being followed up in outpatient department for 9 months without relapse.

Conclusion: Laparoscopic lumber artery ligation is safe and technically feasible procedure for the treatment of type II endoleak after EVAR.

 

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