Endovascular Treatment of Type II Endoleak Following Thoracic Endovascular Aortic Repair for Thoracic Aortic Aneurysm: Case Report of Squeeze Technique to Reach the Aneurysmal Sac

Thoracic endovascular aortic repair (TEVAR) has been accepted as an alternative to open surgical repair in certain groups of patients (1). A potential complication caused by persistent or recurrent flow into the aneurysm sac is known as endoleak which can be classified to four types (2). Complex type II endoleaks occur due to persistent reverse blood flow through branch vessels (3). Common sites of type II endoleaks are the left subclavian artery and intercostal arteries with occasionally bronchial arteries (4). Arterial pressure in type II endoleaks is transmitted to the aneurysm sac, causing sac expansion. In this situation, patients remain at risk of aneurysm rupture (3). Treatment of type II endoleaks requires elimination of blood flow through branch vessels to relieve the aneurysm sac from systemic pressure (3). Various methods are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein present a case of type II endoleak caused by reverse blood flow from the intercostal artery after TEVAR which was successfully treated with the use of histoacryl-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.