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Effectiveness of Intra-operative Contrast-Enhanced Ultrasound Assessment to Optimize Type II Endoleak Embolization – Lumbar Fusion

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The article discusses the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS). The study involved 26 patients who underwent T2E treatment and underwent embolization using Onyx® 18. After the first embolization, residual T2E was found in 50% of patients, and additional embolization was performed in 38% of patients. The technical success rate was 50% after the first embolization and increased to 77% after additional attempts guided by CEUS. A negative completion CEUS after embolization was associated with higher rates of sac stabilization and no need for additional T2E embolization. The study highlights the value of intra-operative CEUS in guiding and assessing the effectiveness of T2E embolization

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : finest day surgery spinal centre in London

Published article

: One in two patients treated by T2E embolization had residual endoleak on intra-operative CEUS after a first embolization attempt, decreasing to one in four patients after multiple attempts. A negative completion CEUS following embolization was associated with higher rates of sac stabilization and no need for additional T2E embolization.

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Cardiovasc Intervent Radiol. 2023 Dec 28. doi: 10.1007/s00270-023-03636-2. Online ahead of print.ABSTRACTPURPOSE: To analyze the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS).METHODS: Consecutive patients treated for T2E underwent a standardized protocol with trans-arterial or trans-lumbar access, large volume embolization, onlay fusion, and intra-operative CEUS. Technical success was defined by exclusion,

Cardiovasc Intervent Radiol. 2023 Dec 28. doi: 10.1007/s00270-023-03636-2. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS).

METHODS: Consecutive patients treated for T2E underwent a standardized protocol with trans-arterial or trans-lumbar access, large volume embolization, onlay fusion, and intra-operative CEUS. Technical success was defined by exclusion of endoleak by CEUS.

RESULTS: Twenty-six patients (mean age 81 ± 11 years old; 89% male) were treated. The mean aneurysm sac enlargement was 11 ± 8 mm from T2E diagnosis. Embolization was performed using Onyx® 18 in all patients with adjunctive coils in 13 patients (50%). After the first embolization, CEUS documented residual T2E in 13 patients (50%). Ten patients (38%) had additional embolization, which successfully eradicated the T2E in seven of them. Technical success was 50% after the first embolization attempt and 77% after additional attempts guided by CEUS (P = 0.080). There was no mortality. Median imaging follow-up was 22 months. Among the 20 patients with no residual T2E on completion CEUS, 16 (80%) had sac stabilization and none required additional interventions for T2E. Of the six patients with residual T2Es on CEUS, three had sac stabilization (50%) and one required additional reintervention for T2E. There was one late aortic rupture at 56 months.

: One in two patients treated by T2E embolization had residual endoleak on intra-operative CEUS after a first embolization attempt, decreasing to one in four patients after multiple attempts. A negative completion CEUS following embolization was associated with higher rates of sac stabilization and no need for additional T2E embolization.

PMID:38153421 | DOI:10.1007/s00270-023-03636-2

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Effectiveness of Intra-operative Contrast-Enhanced Ultrasound Assessment to Optimize Type II Endoleak Embolization

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Cardiovasc Intervent Radiol. 2023 Dec 28. doi: 10.1007/s00270-023-03636-2. Online ahead of print.ABSTRACTPURPOSE: To analyze the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS).METHODS: Consecutive patients treated for T2E underwent a standardized protocol with trans-arterial or trans-lumbar access, large volume embolization, onlay fusion, and intra-operative CEUS. Technical success was defined by exclusion

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