Pre-emptive Sac Management to Prevent Type II Endoleaks in High-Risk Patients.

Although the significance of type II endoleaks (T2ELs) has been debated for decades, it has been shown to be associated with sac diameter increase, reinterventions, and even rupture. Since interventions for established T2ELs have been associated with low success rates, pre-emptive side branch or nonselective sac embolization/filling with various coils, liquid agents, or thrombogenic materials has been reported since the early 2000s. In this issue of JVIR, Miura et al (1) present their approach to preventing T2EL in patients who have patent lumbar arteries (LAs) with occluded inferior mesenteric artery (IMA), or following IMA coil embolization, by covering the ostia of patent LAs using nonselective sac liquid embolization with n-butyl cyanoacrylate (nBCA) (Trufill; Johnson & Johnson, New Brunswick, New Jersey).