ABSTRACT
As type I endoleaks are uniformly considered a reason for urgent reintervention, type II endoleaks generally are being observed since spontaneous thrombosis frequently occurs (1–5). In the case of persistence of the endoleak beyond 6 months with failure of the aneurysm to shrink or increase of aneurysm diameter, however, therapeutic intervention may be indicated (6–8). Catheter embolization of patent lumbar of inferior mesenteric arteries, either alongside the limbs of the graft or via superior mesenteric or hypogastric arteries, had proven to be a valuable treatment option (9). However, this method may not be technically feasible in all cases due to tortuosity of the collateral circulation or multiplicity of patent connections to the aneurysm sac. Efficacy of direct injection of thrombogenic material into the aneurysm sac is debated since pressure in the aneurysm may remain unaltered (10,11). Recently, we reported a laparoscopic approach for treatment of a patient in whom treatment of persistent type II endoleak was deemed necessary and catheter embolization unlikely to succeed (12). In this 212chapter we describe in detail our surgical technique as well as the early clinical results of clipping of lumbar and inferior mesenteric arteries via a laparo-endoscopic, retroperitoneal approach as a minimally invasive surgical treatment option for persistent type II endoleak.
