Transarterial Embolization Using the Quintet-coaxial Catheter System for a Type II Endoleak after Endovascular Aneurysm Repair

<b>Purpose:</b> Transarterial embolization of the internal iliac artery-associated type II endoleaks necessitates adequate support to approach the abdominal aortic aneurysm sac. Herein, we report initial experience with transarterial embolization of the internal iliac artery-associated type II endoleaks using the quintet-coaxial catheter system. <b>Techniques:</b> The quintet-coaxial catheter system consisted of the following five coaxial devices: a 5-F thin-walled flexible guiding sheath, a 5-F guiding catheter, a 3.4-F large-bore distal access catheter, a 2.7-F high-flow microcatheter, and a 1.9-F microcatheter. From the ipsilateral femoral artery, the system was advanced into the abdominal aortic aneurysm sac via a long, thin, and tortuous access route arising from the lumbar and iliolumbar arteries. Embolization using a 20% mixture of n-butyl 2-cyanoacrylate with iodized oil was successfully performed in three cases with sac expansion caused by a persistent internal iliac artery-associated type II endoleaks. The inflow artery was embolized using metallic coils through the 2.7-F microcatheter. The 3.4-F large-bore distal access catheter improved the stability of the double coaxial microcatheter system and facilitated the access of the 1.9-F microcatheter to the abdominal aortic aneurysm sac. <b>Conclusions:</b> The quintet-coaxial catheter system enables the embolization of type II endoleaks through long, thin, and tortuous access routes.