Balloon-assisted transcaval embolization of a type II endoleak associated with an aortocaval fistula after endovascular aortic repair

Endovascular aortic repair is an accepted treatment option for patients with infrarenal aortic aneurysm. Type II endoleak associated with persistent aneurysmal sac growth is considered an adverse event requiring endoleak occlusion. We describe the case of a patient with type II endoleak after endovascular aortic repair for infrarenal aortic aneurysm associated with aortocaval fistula and persistent aneurysm growth. Type II endoleak embolization was successfully performed with coils and Onyx through a transcaval approach using an occlusion balloon and co-axial microcatheter.