Abstract
Control of back bleeding from the hypogastric artery into the aneurysm after endovascular aneurysm repair (EVAR) of a ruptured aorto-iliac aneurysm may be necessary in order to avoid a type II endoleak. It is an emergency situation and selective catheterization and embolization of the hypogastric artery may be time-consuming and more importantly, it has to be performed before complete exclusion of the aneurysm has been established. We describe a plugging and sealing technique that embolizes the hypogastric artery after the exclusion of a ruptured aorto-iliac aneurysm using the embolizing agent Onyx. The mortality rate of the 16 patients treated in our institute with this technique was 25% (4/16) at 30-day and 31% (5/16) at 90-day follow up. One patient had a type II endoleak at one-year follow-up. The EVAR procedure can focus completely on controlling the acute life-threatening situation, with the embolization performed at the end of the procedure.
MeSH terms
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Aortic Aneurysm, Abdominal / diagnostic imaging
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Aortic Aneurysm, Abdominal / mortality
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Aortic Aneurysm, Abdominal / physiopathology
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Aortic Aneurysm, Abdominal / surgery
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Aortic Aneurysm, Abdominal / therapy*
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Aortic Rupture / diagnostic imaging
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Aortic Rupture / mortality
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Aortic Rupture / physiopathology
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Aortic Rupture / surgery*
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Blood Vessel Prosthesis Implantation* / adverse effects
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Blood Vessel Prosthesis Implantation* / mortality
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Drug Combinations
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Embolization, Therapeutic / adverse effects
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Embolization, Therapeutic / methods*
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Embolization, Therapeutic / mortality
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Endoleak / etiology
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Endoleak / mortality
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Endoleak / prevention & control*
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Endovascular Procedures* / adverse effects
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Endovascular Procedures* / mortality
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Humans
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Iliac Aneurysm / diagnostic imaging
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Iliac Aneurysm / mortality
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Iliac Aneurysm / physiopathology
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Iliac Aneurysm / surgery*
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Pelvis / blood supply*
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Polyvinyls / adverse effects
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Polyvinyls / therapeutic use*
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Radiography
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Tantalum / adverse effects
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Tantalum / therapeutic use*
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Time Factors
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Treatment Outcome
Substances
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Drug Combinations
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Onyx 18
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Polyvinyls
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Tantalum