Effectiveness of Embolization of Inferior Mesenteric Artery to Prevent Type II Endoleak Following Endovascular Aneurysm Repair: A Review of the Literature

Abstract

Type II endoleak is a common complication that develops after endovascular aneurysm repair. Patients with type II endoleak, which has persisted for 6 months, have a significantly higher rate of aneurysmal sac enlargement, reintervention, and rupture. To date, several studies have examined the effectiveness of preoperative embolization of branch vessels for the prevention of type II endoleak. Particularly, the embolization of the large inferior mesenteric artery (IMA) seems to be a precise, safe, and effective method. IMA is a significant risk factor for type II endoleak. However, there is currently no strong evidence to prove which patients would benefit from preventive IMA embolization. In addition, considering the incidence of type II endoleak and the adverse event rate, routine embolization seems to be unreliable and time-consuming. Moreover, previous reports of preoperative IMA embolization were retrospective. Thus, prospective and randomized studies are necessary so that the usefulness of IMA embolization can be proved and the potential benefits can be assessed. To establish preventive IMA embolization as one of the effective therapeutic strategies to prevent type II endoleak and to maximize its therapeutic effect, we should provide a wide range of therapeutic strategies to suit the state of the patient.

Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan

“…Current guidelines suggest that a conservative approach is appropriate for isolated type II endoleaks without sac expansion [24,25]. Intervention is recommended when there is a sac enlargement of more than 10 mm [24,25].…”

“…In this series, most type II endoleaks resolved spontaneously, and only 3 patients required intervention. Nevertheless, secondary interventions for type II endoleaks are often unsatisfactory as recurrence is common, and long-term follow-up is also mandatory [24,25].…”

Techniques and future perspectives for the prevention and treatment of endoleaks after endovascular repair of abdominal aortic aneurysms

“…Muthu et al [37] in a study performed in 2007 where patients that received IMA embolisation combined with intraprocedural thrombin injection in 69 consecutive patients that underwent elective EVAR showed a trend of endoleak reduction; however, no statistically significant difference was reached (26% compared with 14%) and the authors concluded that ongoing research into means to prevent lumbar endoleaks is required. Even though there is a variety of studies available, there is still not enough evidence to support routine embolisation of the IMA or the lumbar arteries or intraprocedural thrombin injection prior to routine EVAR and this remains an operator’s preference [38].…”

Recent Advances and Mid-to-Long Term Results of Endovascular Aneurysm Repair for Abdominal Aortic Aneurysms

“… 29 ) We are currently conducting an RCT (UMIN000022147) to target type II EL high-risk cases with one of the above 3 risk factors and aim to determine whether IMA embolization during EVAR can inhibit type II EL. 29 ) If a few slight adjustments are made, operative time, irradiation time, and contrast medium volume for IMA embolization during EVAR could be comparable with cases which do not undergo embolization, which is acceptable as an option during EVAR. 30 ) We plan to discuss the utility of this procedure following the conclusion of the ongoing RCT.…”