# Super-Selective Embolization Using Flow-Directed Microcatheter and 0.010-inch Microwire for Type II Endoleak Following Thoracic Endovascular Aortic Repair: A Three-Case Report

## TL;DR

This case report describes a new embolization technique using specialized tools to treat persistent type II endoleaks after aortic repair, showing initial success but requiring long-term monitoring.

## Contribution

The study introduces the use of flow-directed microcatheters and 0.010-inch microwires for embolization in complex type II endoleaks following TEVAR.

## Key findings

- Endovascular embolization using flow-directed microcatheters successfully treated aneurysm growth in three cases of persistent T2EL.
- Combining NBCA with coils provided more stable embolization in larger aneurysmal sacs compared to NBCA alone.
- Follow-up imaging revealed new endoleaks in two cases, highlighting the need for continued monitoring.

## Abstract

Type II endoleak (T2EL) following thoracic endovascular aortic repair (TEVAR) may lead to progressive aneurysm enlargement, necessitating further intervention. This report presents 3 cases of persistent T2EL with aneurysm growth after TEVAR, and managed through endovascular embolization using flow-directed microcatheters and 0.010-inch guidewires, employing N-butyl cyanoacrylate (NBCA) either alone or in combination with coils. Aneurysmal sac embolization was successfully performed in all cases, despite significant vascular tortuosity, resulting in favorable immediate outcomes without complications. A key advantage observed was the ability of flow-directed microcatheters to navigate into distal, tortuous feeding vessels that are typically inaccessible using conventional methods. While NBCA alone was effective for embolizing small sacs, a combination of coils and NBCA provided more controlled and stable embolization in larger sacs. However, follow-up computed tomography revealed new endoleaks in 2 cases, emphasizing the need for continued monitoring. While short-term results are promising, further studies are needed to assess long-term recurrence risks. This case series highlights the effectiveness of flow-directed microcatheters, 0.010-inch microwires, and targeted embolization techniques in managing T2EL following TEVAR.