Embo-EVAR: A Technique to Prevent Type II Endoleak? A Single-Center Experience

Natrella, Massimiliano; Rapellino, Alessandro; Navarretta, Federico; Iob, Gianluca; Cristoferi, Massimo; Castagnola, Matteo; Lunardi, Gianmarco; Duc, Luca; Fanelli, Gianluca; Cornetto, Andrea Peruzzo; Meloni, Teodoro; Peinetti, F

doi:10.1016/j.avsg.2017.01.028

Cited by 21 publications

(16 citation statements)

References 19 publications

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“…When we compare the preventive sac embolization only (coils + glue) with selective sac branch embolization we can confirm that the selective approach is more efficient and has fewer artifacts and embolization materials. When we compare longer clinical outcomes, we can confirm there is no statistical evidence that sac preventive embolization has long-term efficiency as a technique to prevent EL2 [21,22]. It is recommended to embolize IMA and LA before SG deployment when the lumen diameter is more than 2-3 mm or if the number of patent LAs is more than 3.…”

Section: Discussionmentioning

confidence: 88%

“…This technique can have side effects regarding sac and neck dilatation, and expansion in the sac can lead to misplacement of the SG and further complications [20]. Aneurysm sac embolization [21,22] during the EVAR procedure using coils and glue can decrease the rise of endoleak, reduce sac volume, and improve its shrinkage. This method was described with a lower rate of reintervention due to EL2, but statistically, there was no clear outcome to confirm this technique as the best solution for prevention.…”

Section: Prevention Of El2mentioning

confidence: 99%

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Treatment of the Progressive Endoleak Type 2 After EVAR

Dobeš¹

2019

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice

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An endoleak type 2 (EL2) is a relatively frequent event after an EVAR but 30-35% of EL2 can become progressive, which can cause a loss in the important sealing zone of the stent graft. Diagnosis is made by three-phase CT angiogram or by contrast-enhanced duplex scan. EL2 should be treated if the aortic sac grows more than 5 mm in 6 months time. The first suitable treatment is the endovascular approach with embolization of the inferior mesenteric artery (IMA) or lumbar arteries. Paravertebral puncture, under CT navigation to embolize the lumbar artery or a part of the aortic sac with the EL2, is another alternative. If the endovascular treatment is not successful in 2-3 times, we should consider a surgical approach. The operative approach can be a laparoscopic or an open operation: the laparoscopic approach allows us to clip the IMA and lumbar arteries. The open surgery involves laparotomy, ligation of the IMA, and endoaneurysmorrhaphy (suture of lumbar artery origins from inside) and then the suture of the aortic sac tightly around the stent graft in situ. The aortic occlusion balloon should be inserted below the renal arteries prior to open surgery. The surgical procedures have good outcomes and should be considered when the endovascular treatment is unsuccessful.

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Section: Discussionmentioning

confidence: 88%

Section: Prevention Of El2mentioning

confidence: 99%

Treatment of the Progressive Endoleak Type 2 After EVAR

Dobeš¹

2019

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice

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“…However, this pales in comparison to wholly endovascular procedures, where radiation exposure occurs during preoperative planning, graft placement and follow-up checks. For instance, radiation exposure has been reported to be as long as 44 min in aneurysm sac embolization procedures, 53 and the impact of radiation exposure associated with endovascular aneurysm repairs may be harmful given well-recognised carcinogenic risks. 54,55 In this light, vascular surgeons should strive to practise the judicious use of CT-scans and if possible to maintain the lowest dose possible reasonably.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ligation of Type II endoleaks following endovascular aneurysm repair: A systematic review

et al. 2018

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“…The search identified 898 articles of potential interest (Figure 1); another 6 were found in a search of reference lists. After eliminating ineligible/irrelevant articles, 125 full-text articles were reviewed; 17 studies 12 –28 published between 2002 and 2018 encompassing 2084 patients were ultimately selected for inclusion in the meta-analysis.…”

Section: Methodsmentioning

confidence: 99%

Sac Embolization and Side Branch Embolization for Preventing Type II Endoleaks After Endovascular Aneurysm Repair: A Meta-analysis

Hou

2019

J Endovasc Ther

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Purpose:To investigate the efficacy and safety of preoperative side branch embolization or intraoperative sac embolization for preventing type II endoleaks after endovascular aneurysm repair (EVAR). Materials and Methods: A systematic literature search of MEDLINE and EMBASE was performed to identify studies that evaluated the outcomes of sac embolization vs no embolization or side branch embolization vs no embolization in patients who received EVAR. Among the 904 studies screened, 17 studies with 2084 participants were included in this review. Outcome measures included the type II endoleak rate, the reintervention rate for type II endoleaks, the incidence of types I/III endoleaks, and the rate of complications. Fixed (no heterogeneity) or random effects models were constructed for each outcome; the results are presented as the odds ratio (OR) with 95% confidence interval (CI). Results: The sac embolization group had significantly lower type II endoleak (OR 0.21, 95% CI 0.13 to 0.34, p<0.001) and reintervention (OR 0.15, 95% CI 0.07 to 0.33, p<0.001) rates than the no embolization group. No significant differences between the 2 groups were found for the type I/III endoleak rate (OR 0.57, 95% CI 0.23 to 1.37, p=0.21) or complication rate (OR 1.22, 95% CI 0.32 to 4.70, p=0.77). Compared with no embolization, side branch embolization was also associated with a decrease in type II endoleak (OR 0.35, 95% CI 0.21 to 0.60, p<0.001) and reinterventions (OR 0.10, 95% CI 0.04 to 0.27, p<0.001). One severe procedure-related complication (fatal colon ischemia) was reported in the side branch embolization group. Conclusion: Sac embolization and side branch embolization are safe and effective in preventing type II endoleaks. Further randomized trials are needed to directly compare the clinical outcomes of these procedures.

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Embo-EVAR: A Technique to Prevent Type II Endoleak? A Single-Center Experience

Cited by 21 publications

References 19 publications

Treatment of the Progressive Endoleak Type 2 After EVAR

Treatment of the Progressive Endoleak Type 2 After EVAR

Laparoscopic ligation of Type II endoleaks following endovascular aneurysm repair: A systematic review

Sac Embolization and Side Branch Embolization for Preventing Type II Endoleaks After Endovascular Aneurysm Repair: A Meta-analysis

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