Type II endoleak and aortic aneurysm sac shrinkage after preemptive embolization of aneurysm sac side branches

Prophylactic sac outflow vessel embolization is associated with improved sac regression in patients undergoing endovascular aortic aneurysm repair

“…This is consistent with the limited available studies, which have reported an exceedingly low incidence of clinically significant ischemic complications. 12 The emboEVAR group demonstrated significantly more frequent sac reduction at mid-term follow-up compared with the EVAR-alone group despite comparable rates of T2Es at case completion. We postulated that sac outflow vessels would require an interval to become thrombosed after embolization, especially because of the common practice of intraoperative anticoagulation use.…”

“…However, the findings from the present study were comparable or better than the procedural characteristics reported previously for aortic sac branch vessel embolization. 12,13 In addition, the increased procedural risk was not associated with an increase in intraoperative or postoperative complications or length of stay. Ischemic complications are also an important theoretical concern; however, the complication rates have been infrequently documented in previous studies and were reported in only 6 of 13 small sample size studies in a recent meta-analysis of prophylactic aortic branch vessel embolization.…”

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

“…For instance, the decision between EVAR and open surgery could be reconsidered. Furthermore, the EVAR procedure might be optimized in selected patients with a lower likelihood of AAA shrinkage by including active sac management—such as embolization of side branches or filling the aneurysmal sac—prior to the procedure [ 36 , 37 ]. Reliable prediction of AAA remodeling could also aid stratification of the follow-up surveillance after EVAR based on the patient’s individual risk.…”

How I Do It: Computed Tomography–Guided Modified Translumbar Embolization of Type 2 Endoleak

“…Besides conventional endoleak embolization techniques, new and unique approaches have also been described, including preoperative embolization of aortic side branches, intraoperative embolization of aneurysm sac, transcatheter transcaval embolization under fluoroscopy or intravascular ultrasound, and sac embolization with balloon occlusion of the aorta. 4,[9][10][11][12][13][14] Recent data suggest that patients with stable to enlarging aneurysm sacs have worse outcomes than those with shrinking aneurysm sacs. Since type 2 endoleaks are associated with inferior sac regression, there has been an interest in the value of alternative and more aggressive type 2 endoleak management.…”

“…Both techniques showed positive outcomes in preventing type 2 endoleaks and resulting in aneurysm sac shrinkage. 10,11 For patients with an unsuccessful transarterial attempt and limited window for percutaneous translumbar access, the transcaval embolizations have shown promising results. 4,9 Sac embolization using liquid embolic with balloon occlusion of the aorta has also been described in the treatment of type 2 endoleak.…”