Prevention des endofuites de type II

A.CARDON, A.KALADJI, B.LAVIOLLERENNESPREVENTIVE TREATMENT OF TYPE II ENDOLEAK

ISSUES WITH EVAR

REINTERVENTION

Greenhalgh et al. NEJM 2010De Bruin et al. NEJM 2010

Schanzer et al. Circ 2010

n>10 000 patients

REINTERVENTIONS :

Rennes, n=330 patientsRENNES EXPERIENCE : NATURAL HISTORY of type II ENDOLEAK

PREVENTION : EMBOLIZATION WITH COILSParry et . JVS 200216 patients (no control group): Embolization with coils IMA +/- lumbar arteriesGood results on aneurysmal shrinkage

Nevala et al. JVIR 201040 patients (with a control group) : embolization IMA with coilsReduction of type II endoleak but no more aneurysmal shrinkage+++ (22% vs 59%)

PREVENTION : COILS + THROMBINMuthu et al. JEVT 200770 patients (with control group) : coils in IMA + thrombin in the sacThrombin : Exogenous solution No reduction of type II endoleak (14% vs 26%)Less reintervention (p=0.03 mais no difference in km)

Pilon et al. ICTS 200920 patients (with control group) : coils (platinium)+ thrombin both in the sacLess type II Endoleak (6% vs 30%) but p=0.05

PREVENTION : THROMBIN INJECTIONRonsivalle et al. JEVT 2010180 patients (224 control group before 2003) : thrombin injection in the sac +/- coils)Exogenous solution : TissucolRate of type II endoleak : 2.4% vs 15.2% at 24 months (p