BackTable Vascular & Interventional Ep. 583 Managing Type II Endoleaks: Techniques & Tools with Dr. Matthew Givens
Oct 21, 2025
Dr. Matthew Givens, Chief of Interventional Radiology at the New Orleans VA and LSU Health faculty, delves into the complexities of managing type II endoleaks. He shares his first-line approach involving transarterial access via the inferior mesenteric artery and discusses techniques for embolization, focusing on the use of long soft framing coils and liquid embolics. The conversation also covers the challenges of navigating complex sac anatomy and the benefits of various access techniques, all while emphasizing collaboration with vascular surgeons.
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Ruptured Type II Endoleak Managed Perigraft
- Dr. Givens once treated a ruptured aneurysm caused by a type II endoleak during a locum in Savannah.
- He entered perigraft, packed coils and glue, and stabilized the patient emergently.
Think Of Type II Endoleaks As AVMs
- Treat type II endoleaks like AVMs: target the nidus while also considering inflow and outflow vessels.
- Removing the primary inflow (often the IMA) plus nidus obliteration gives the best durable results.
Start With Transarterial IMA Targeting
- First attempt transarterial access via the SMA → middle colic → marginal artery to reach and embolize the IMA.
- If you can't reach the nidus, embolize the IMA and stage a transcaval/translumbar on another visit.