Evaluation and Coil Embolization of the Aortic Side Branches for Prevention of Type II Endoleak after Endovascular Repair of Abdominal Aortic Aneurysm

Abstract

Objectives: Aneurysm shrinkage after EVAR is the strong factor of favorable outcomes after endovascular abdominal aortic aneurysm repair (EVAR), and type II endoleaks is the risk factor of no aneurysm shrinkage or aneurysm enlargement in the long term. In this study, we evaluate the aortic side branches relate to early postoperative type II endoleak, and performed coil embolization for those vessels for prevention of type II endoleak.Methods: Patency and diameter of aortic side branches including inferior mesenteric artery (IMA) and lumbar artery (LA) were evaluated in 56 consecutive patients with abdominal aortic aneurysm who were scheduled for EVAR. Coil embolization with Interlock was performed in 24 patients during EVAR for all patent IMA and LA with maximal diameter more than 2.0 mm. Computed tomography was performed one week after EVAR for evaluation of endoleak.Results: In patients with IMA more than 2.5 mm in diameter, the frequency of type II endoleak was approximately 90% regardless of the number of patent LA. In case with patent IMA less than 2.5 mm or with 2 or more patent LA larger than 2.0 mm, the frequency of type II endoleak was 46 to 67%. Coil embolization for IMA was successfully performed in 15/16 patients (94%). Coil embolization of LA was performed for patent LA larger than 2.0 mm and 29 out of 45 LA (64%) were successfully occluded. There was no perioperative complication associated with coil embolization. The frequency of type II endoleak was significantly lower in patients with coil embolization than those without coil embolization (4.2% vs 58.9%, p<0.0001).Conclusion: Patent IMA and LA in diameter larger than 2.0 mm were associated with type II endoleak one week after EVAR, and coil embolization with Interlock during EVAR is safe and effective procedure to prevent type II endoleak. (This is a translation of Jpn J Vasc Surg 2016; 25: 321–328.)

Predictive Factors and Strategies to Prevent the Development of Type 2 Endoleaks following Endovascular Aneurysm Repair

“…19 Lumbar arteries with diameters larger than 2 mm are more likely to lead to Type 2 endoleaks. 22 Preoperative coil embolization of lumbar artery branches can reduce incidence of Type 2 endoleak in these patients. 22 Other techniques to prevent Type 2 endoleaks that can be performed intraoperatively are described in the literature.…”

“…22 Preoperative coil embolization of lumbar artery branches can reduce incidence of Type 2 endoleak in these patients. 22 Other techniques to prevent Type 2 endoleaks that can be performed intraoperatively are described in the literature. Direct injection of the aneurysm sac with thrombin appears to be an additional safe procedure that reduces incidence of Type 2 endoleaks.…”

“…21 Coils are a commonly used embolic agent for this procedure. 17,22 IMA embolization is generally considered to be a safe procedure, with most patients having no evidence of complications. 17 The most common complication is nonlocalized abdominal pain, which resolves with supportive management.…”

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

“… 13 , 14 ) Several studies have examined the effectiveness of preoperative, not postoperative, embolization of side branches to prevent type II endoleak. 15 – 25 ) Moreover, reports suggest that sac embolization during EVAR reduced type II endoleak. 25 – 27 )…”

“… 15 – 25 ) Moreover, reports suggest that sac embolization during EVAR reduced type II endoleak. 25 – 27 )…”