Ultrasound and computed tomography-guided thrombin injection of a type 2 endoleak

Introduction. - Type II endoleaks are a well-documented complication of endovascular aortic aneurysm repair. This case demonstrates the successful combined use of duplex ultrasound to assist in the percutaneous treatment of type II endoleaks. Case report. - A 75 year-old man who had previously undergone endovascular aortic aneurysm repair was found to have a type II endoleak. As the result of failure of the transfemoral endovascular coil embolization to repair the leak, the patient underwent computed tomography- and ultrasound-guided thrombin injection of the aneurysm sac via a trans-lumbar approach. Duplex ultrasound proved useful in guiding the placement of the translumbar needle, in confirming the thrombosis of the endoleak, and in demonstrating continued patency of the endograft. Conclusion. - The two imaging modalities worked in a complementary fashion to guide needle placement and to enable real-time imaging of color-enhanced flow within the aneurysm sac.