Total Laparoscopic Inferior Mesenteric Artery Ligation and Direct Sac Puncture Embolization Technique for Treatment of Type II Endoleak

Vasc Endovascular Surg . 2020 Apr;54(3):278-282. doi: 10.1177/1538574419885271. Epub 2019 Nov 22.

Fecha de la publicación: 22/11/2019

Autor: Enrique M San Norberto (1), Liliana A Fidalgo-Domingos (1), Alejandro Romero (2), Carlos Vaquero (1)

Palabras clave: Abdominal aortic aneurysm, Endoleak, Endovascular procedure, Laparoscopy, Therapeutic embolization



1Division of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.

2Division of General Surgery, Valladolid University Hospital, Valladolid, Spain.


Type II endoleak relates to aneurysm perfusion through a patent branch vessel. Reintervention for type II endoleak should be considered in the presence of significant aneurysm growth. Recurrences and subsequent reinterventions are frequent by occult type II endoleaks through feeder arterial branches. We report a case of a patient with a type II endoleak due to inferior mesenteric artery (IMA) patency associated with aneurysm sac growth after an unsuccessfully attempt of transarterial embolization. Laparoscopic ligation of the IMA with direct sac puncture embolization was performed. The postoperative and 1-year follow-up computed tomography angiography scan demonstrated no endoleak signs and aneurysm sac shrinkage. The proposed modification of this technique constitutes a novel approach to this entity. Total laparoscopic IMA ligation and direct sac puncture embolization technique may increase the success rate for the treatment of endoleaks type II by excluding the recurrences. This technique may offer a safe, feasible, and minimally invasive approach for type II endoleaks when other endovascular techniques are unsuccessful.