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Purpose: To retrospectively assess immediate and 1-year success rate of type 2 endoleak (T2E) treatment with ethylene-vinyl-alcohol-polymer using three-dimensional (3D) image fusion guidance with cone beam computed tomography via trans-arterial embolization (TAE) or direct percutaneous sac injection (DPSI)., Materials and Methods: A total of 37 patients with T2E who were treated either using TAE (34/37; 92%) or DPSI (9/37; 8%) were included. There were 34 men and 3 women with a mean age of 86±9 (SD) years (range: 67-104years). Mean aneurysm diameter was 67±14 (SD) mm (range: 42-101mm) at pre-procedure evaluation. Immediate success was complete embolization of the sac and feeding artery. 1-year success was reduction or stability of the aneurysmal sac diameter based on pre-procedure and 12-month follow-up examinations. Safety (treatment-related complications), patient demographics, duration of procedure and contrast volume were reported., Results: Immediate and 1-year successful outcomes were reported in 94% (n=32) and 88% (n=28) of patients after TAE and 100% (n=9) and 89% (n=8) after DPSI. T2E treatments were immediately successful for 95% of the procedures (41/43) and for 88% (36/41) at 1year. Overall, T2E treatment was effective in 33 patients (89%). No major complications occurred. Mean procedure time and contrast volume were significantly different between the 2 techniques with respectively 87±16 (SD) min (range: 65-120min) and 75±26 (SD) mL (range: 40-130mL) for TAE and 32±10 (SD) min (range: 20-50min) (P<0.01) and 6±6 (SD) mL (range: 2-22mL) (P<0.01) for DPSI. Mean aneurysm diameter at 1-year was 68±17 (SD) mm (range: 43-101mm). No significant differences in the pre-procedure sac diameter were found at long-term follow-up between patients without T2E and those with persistent T2E (P=0.1) in the successful embolization group (n=33)., Conclusion: TAE or DPSI treatments of T2E with ethylene-vinyl-alcohol-polymer using 3D-image fusion guidance were immediately successful for 95% of the procedures and remained effective for 88%. Longer follow-up is necessary to assess sac stability in the case of persistent endoleak., (Copyright © 2020 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Magnetic resonance (MR) angiography image fusion (IF) with live fluoroscopy guidance was used while performing endovascular repair of abdominal aortic aneurysm (EVAR) in five patients with a history of chronic renal disease or severe contrast allergy. Intraprocedural technical success was 100%. Median procedure time was 120 minutes (range, 60-180 min), fluoroscopy time was 40 minutes (range, 17-65 min), dose-area product was 245,867 mGy × cm(2) (range, 68,435-690,053 mGy × cm(2)), and iodinated contrast volume injected was 15 mL (range, 0-40 mL). Technical success was achieved in four of five patients (80%); one case was complicated by a type 1 endoleak on follow-up MR angiography, which was successfully treated. EVAR with MR angiography IF guidance was technically feasible and safe in five patients and reduced or eliminated the use of iodinated contrast media., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)