Intraprocedural and postprocedural perigraft arterial sac embolization (PASE) for endoleak treatment

Intervention may be necessary in up to one-third of patients with endoleaks after endovascular aortic aneurysm repair (EVAR). Perigraft arterial sac embolization (PASE) to induce aneurysm thrombosis was performed by intrasac injection of thrombin and gelfoam slurry. Thirteen patients were treated with PASE since 2006. Eight patients underwent immediate PASE, and five patients were treated during surveillance following EVAR. The median follow-up is 23.9 months (range, 2.6-66.1 months) for the entire cohort; 24.4 and 23.1 months for the immediate and delayed group, respectively. No patients had further aneurysm growth. One (8%) patient maintained stable aneurysm size with a persistent type II endoleak, and 11 (85%) patients had aneurysm shrinkage. PASE to induce sac thrombosis after EVAR is an alternative for the treatment of endoleaks. Further study is required to define optimal patient selection, safety, long-term efficacy and potential cost-savings of this technique.