^ CLINICAL INVESTIGATION —————————————————————————— ^ Treatment of Type II Endoleak After Endovascular Aneurysm Repair: The Role of Selective vs. Nonselective Transcaval Embolization Roberto Gandini, MD; Marcello Chiocchi, MD; Giorgio Loreni, MD; Costantino Del Giudice, MD; Daniele Morosetti, MD; Antonio Chiaravalloti, MD; and Giovanni Simonetti, MD Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University Hospital Tor Vergata, Rome, Italy. ^ ^ Purpose: To assess the technical and midterm results in the treatment of type II endoleaks comparing nonselective (nTCE) vs. selective (sTCE) transcaval embolization. Methods: During a 4-year period, 26 patients (18 men; median age 73 years, range 68–78) underwent direct transcaval aneurysm puncture followed by embolization of the sac (nTCE, n ¼ 9) or of the feeding vessels (sTCE, n ¼ 17). Intrasac pressure was recorded immediately after aneurysm sac puncture and at the end of the procedure. Technical success was defined as successful deployment of embolization material in the sac or in the feeding vessel. Clinical success was defined as absence of endoleak with stabilization of the sac on follow-up CTA. Results: Technical success was 100% in the 9 patients treated with nTCE. Mean intrasac pressures before and after nTCE were 58.6618.4 (range 51–105) and 6.561.2 mmHg (range 4–9), respectively. Over a mean 25.9611.0 months of follow-up, 4 patients developed recurrent endoleak at a mean 9.763.9 months. Three patients were subsequently treated with sTCE, while the last patient underwent emergency surgery for aneurysm rupture due to an enlarging sac 5 months after nTCE. The 20 patients in the sTCE group had a successful procedure with no recurrence in a follow-up of 24.167.2 months. Mean intrasac pressure was reduced after sTCE from 63.6615.2 mmHg (range 43–120) to 7.862.3 mmHg (range 5– 12). Conclusion: The selective TCE approach appears to be a feasible and effective primary therapeutic option for treating type II endoleak. J Endovasc Ther. 2014;21:714–722 Key words: abdominal aortic aneurysm, endovascular aneurysm repair, endoleak, embolization, type II endoleak, transcaval embolization, coil embolization, sac embolization, selective embolization, complications, sac pressure ^ ^ The management of patients with type II endoleak represents a source of constant debate in the literature. Even though it is widely accepted that type II endoleaks with aneurysm sac growth are not innocuous, the merit of intervention, the optimal timing, the most efficacious modality for diagnosis, and the treatment of type II endoleak are still unresolved. 1 As Rosen and Green 2 described, a reasonable strategy for treatment in patients with type II endoleak might be to intervene in cases of increasing aneurysm size or if the endoleak does not resolve spontaneously within 6 months. The authors declare no association with any individual, company, or organization having a vested interest in the subject matter/products mentioned in this article. Corresponding author: Dr. Giorgio Loreni, University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. E-mail: giorgiolorenihotmail.it 714 J ENDOVASC THER 2014;21:714–722 Q 2014 INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS doi:10.1583/14-4571MR.1 Available at www.jevt.org