Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200060
Jornal Vascular Brasileiro
Case Report

Use of carbon dioxide for therapeutic decision-making in endoleaks: a case report

Uso de CO2 na tomada de decisão terapêutica de endoleak: relato de caso

Adalberto Batalha Megale; Cynthia de Almeida Mendes; Marcelo Passos Teivelis; Carolina Brito Faustino; Kauê Polizel Souza; Nelson Wolosker

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Abstract

Abstract: Endovascular aneurysm repair is currently the most frequently treatment modality for infrarenal aortic aneurysms. Endoleaks are the most common cause of reintervention after endovascular aneurysm repair. It is often unclear which type of endoleak is the correct diagnose, making the treatment decision difficult. We report the case of a 72-year-old man with an endoleak two years after endovascular aneurysm repair. Images suggested a type III endoleak, but this was not confirmed by contrast aortography. We proceeded with the investigation using aortography with carbon dioxide and observed a type IA endoleak. This was successfully treated by implantation of a proximal cuff. A review of the literature shows that the role of carbon dioxide in endoleak management is still unclear. We present a case in which carbon dioxide was essential to both diagnosis and therapeutic decision-making in a type IA endoleak.

Keywords

endoleak, endovascular procedure, aneurism, carbon dioxide, angiography

Resumo

Resumo: O tratamento endovascular dos aneurismas de aorta abdominal é atualmente a modalidade de tratamento mais comum. Os endoleaks representam a causa mais frequente de reintervenção após o tratamento endovascular. O diagnóstico do tipo de endoleak frequentemente é incerto, tornando o tratamento desafiador. Apresentamos o caso de um paciente de 72 anos, com endoleak após 2 anos de tratamento endovascular de aneurisma de aorta abdominal. Os exames de imagem pré-operatórios sugeriam um endoleak tipo III; entretanto, durante aortografia com contraste iodado, não foi possível identificá-lo. Optamos por realizar aortografia com dióxido de carbono (CO2), sendo, então, identificado um endoleak tipo IA, que foi tratado com sucesso com o uso de uma extensão (cuff) proximal. O papel do CO2 no diagnóstico de endoleaks ainda não está claro. Relatamos um caso em que o uso do CO2 foi essencial para o diagnóstico e para a decisão de tratamento do endoleak tipo IA.
 

Palavras-chave

endoleak, procedimento endovascular, aneurisma, dióxido de carbono, angiografia

References

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Submitted date:
05/16/2020

Accepted date:
06/19/2020

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