Skip to main content
Log in

Treatment of Type II Endoleaks with a Novel Agent: Precipitating Hydrophobic Injectable Liquid (PHIL)

  • Technical Note
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Objective

Endovascular aortic aneurysm repair has become the principle technique used to treat abdominal aortic aneurysms. However, its long-term success is limited by complications, including type II endoleaks from lumbar arteries and the inferior mesenteric artery. Treatment of these endoleaks can be difficult. The most commonly performed procedure is embolisation via mesenteric or iliolumbar vessels. Embolic agents currently used include coils, glue and Onyx, all of which have their limitations. Our aim was to assess a novel embolic agent precipitating hydrophobic injectable liquid (PHIL) this is currently used in the treatment by neuro-interventionists in the treatment of cerebral arterio-venous malformations.

Methods

Here we describe three patients successfully treated with PHIL.

Results

All three patients had type II endoleaks which were successfully embolised. PHIL displayed favourable embolic characteristics with good distal penetration, rapid injection speed and a lack of glare artefact on follow-up CT.

Conclusion

PHIL is a promising novel embolic agent in the treatment of type II endoleaks, our initial experience has been positive but larger series will be required to evaluate this further.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg. 2009;50:880–96.

    Article  PubMed  Google Scholar 

  2. Aziz A, Menias CO, Sanchez LA, et al. Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion. J Vasc Surg. 2012;55:1263–7.

    Article  PubMed  Google Scholar 

  3. van Marrewijk CJ, Fransen G, Laheij RJ, et al. EUROSTAR Collaborators. Is a type II endoleak after EVAR a harbinger of risk? causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg. 2004;27:128–37.

    Article  PubMed  Google Scholar 

  4. Cho JS, Park T, Kim JY, et al. Prior endovascular abdominal aortic aneurysm repair provides no survival benefits when the aneurysm ruptures. J Vasc Surg. 2010;52:1127–34.

    Article  PubMed  Google Scholar 

  5. Jones JE, Atkins MD, Brewster DC, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007;46:1–8.

    Article  PubMed  Google Scholar 

  6. Abularrage CJ, Crawford RS, Conrad MF, et al. Preoperative anatomic variables are predictive of persistent type 2 endoleak after EVAR. J Vasc Surg. 2010;52:19–24.

    Article  PubMed  Google Scholar 

  7. Kasirajan K, Matteson B, Marek JM, Langsfeld M. Technique and results of transfemoral super selective coil embolization of type II lumbar endoleak. J Vasc Surg. 2003;38:61–6.

    Article  PubMed  Google Scholar 

  8. Rial R, Serrano F, Vega M, et al. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: translumbar puncture and injection of thrombin into the aneurysm sac. Eur J Vasc Endovasc Surg. 2004;27:333–5.

    Article  CAS  PubMed  Google Scholar 

  9. Wisselink W, Cuesta MA, Berends FJ, et al. Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair. J Vasc Surg. 2000;31:1240–4.

    Article  CAS  PubMed  Google Scholar 

  10. Hinchliffe RJ, Singh-Ranger R, Whitaker SC, Hopkinson BR. Type II endoleak: transperitoneal sacotomy and ligation of side branch endoleaks responsible for aneurysm sac expansion. J Endovasc Ther. 2002;9:539–42.

    Article  PubMed  Google Scholar 

  11. Faries PL, Cadot H, Agarwal G, et al. Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. J Vasc Surg. 2003;37:1155–61.

    Article  PubMed  Google Scholar 

  12. Sheehan MK, Barbato J, Compton CN, et al. Effectiveness of coiling in the treatment of endoleaks after endovascular repair. J Vasc Surg. 2004;40:430–4.

    Article  PubMed  Google Scholar 

  13. Görich J, Rillinger N, Sokiranski R, et al. Embolization of type II endoleaks fed by the inferior mesenteric artery: using the superior mesenteric artery approach. J Endovasc Ther. 2000;7:297–301.

    Article  PubMed  Google Scholar 

  14. Naveed U. SaqiB, KriStofer M, CharltoN, Ali Azizzadeh Managing type II endoleaks. Endovasc Today. 2013;1:45–50.

    Google Scholar 

  15. Samaniego E, Kalousek V, Abdo G, Ortega-Gutierrez S J. Preliminary experience with Precipitating Hydrophobic Injectable Liquid (PHIL) in treating cerebral AVMs. Neurointerv Surg 2016;8:1253–1255.

    Article  Google Scholar 

  16. Leyon JJ, Chavda S, Thomas A, Lamin S. Preliminary experience with the liquid embolic material agent PHIL (precipitating hydrophobic injectable liquid) in treating cranial and spinal dural arteriovenous fistulas: technical note. J Neurointerv Surg. 2016;8:596–602.

    Article  PubMed  Google Scholar 

  17. Karthikesalingam A, Thrumurthy SG, Jackson D, et al. Current evidence is insufficient to define an optimal threshold for intervention in isolated type II endoleak after endovascular aneurysm repair. J Endovasc Ther. 2012;19:200–8.

    Article  PubMed  Google Scholar 

  18. Smith SJ, Thomas A, Ashpole RD. Intra-operative combustion of Onyx embolic material. Br J Neurosurg. 2009;23(1):76–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amir Helmy.

Ethics declarations

Conflicts of interest

No conflicts of interests.

Ethics Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Helmy, A., Shaida, N. Treatment of Type II Endoleaks with a Novel Agent: Precipitating Hydrophobic Injectable Liquid (PHIL). Cardiovasc Intervent Radiol 40, 1094–1098 (2017). https://doi.org/10.1007/s00270-017-1603-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1603-7

Keywords

Navigation