PMC6334184_01
Axial computed tomography in prone position - endoleak type 2 right-sided to the endograft (EL - endoleak, Ur - ureter, VCI - vena cava inferior)
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Endoleak zone within the aneurysm sack was located right to the stent-graft; therefore, direct right retroperitoneal puncture was the safest and the only option to access the sack of the aneurysm (Figure 1).
A) Needle advanced close to vena cava inferior and the ureter - the space between the structures sufficiently splayed with an injection of 5% glucose in water (Glu - glucose in water, Ur - ureter, VCI - vena cava inferior). B) Needle tip in the endoleak zone, shortly before thrombin injection
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After placing the tip of the needle in the area between ureter and vena cava inferior, approximately 20 ml of 5% glucose was injected to achieve so-called hydrodissection in the retroperitoneal space in order to provide sufficient space for safe access to the aorta (Figure 2A). The needle was advanced gently to the aneurysm lumen until the backflow in the needle hub confirmed its correct position (Figure 2B).
Control computed tomography after thrombin injection and needle removal- no persistent endoleak, no haemorrhagic complications, and no ureter injury
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Post-procedural scan with 60 ml of contrast agent in arterial and delayed phase confirmed no signs of endoleak and no complications such as bleeding or damage of the vena cava inferior or ureter (Figure 3).
Follow-up contrast-enhanced ultrasound at six months - stentgraft patent (PG), no endoleak visible
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Follow-up contrast-enhanced ultrasound (CEUS) at the end of hospital stay and at one month and six months confirmed no persistent endoleak (Figure 4).