Inferior Mesenteric Artery Embolization before Endovascular Aneurysm Repair: Technique and Initial Results

Axelrod, David; Lookstein, R.; Guller, Jeffrey; Nowakowski, F.; Ellozy, Sharif H.; Carroccio, Antonio; Teodorescu, Victoria; Marin, Michael L.; Mitty, Harold A.

doi:10.1097/01.rvi.0000141342.42484.90

Cited by 86 publications

(50 citation statements)

References 20 publications

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“…[6][7][8][9] However, some studies have questioned the effectiveness of preoperative embolization of aortic side branches for the prevention of type II endoleak. [9][10][11][12][13] Considering the indications as well as the complications of catheterization of the IMA, computed tomography (CT) findings of the IMA orifice such as stenosis due to mural thrombus or calcification may well be significant. To the best of our knowledge, however, there have been no reports concerning the relationship between persistent type II endoleak from the IMA and CT findings of the IMA orifice.…”

Section: Introductionmentioning

confidence: 99%

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

Fukuda

Matsuda

Sanda

et al. 2014

Annals of Vascular Diseases

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Purpose:To identify the computed tomography (CT) findings of persistent type II endoleak from the inferior mesenteric artery (IMA) which indicate the need for preoperative IMA embolization. Materials and Methods: Included were 120 patients (96 males, 49-93 years old, mean: 77.7) who underwent endovascular aortic aneurysm repair (EVAR) between June 2007 and October 2010. The relationship between persistent type II endoleak and CT findings of IMA orifice was examined. Results: CT showed no type II endoleak from IMA in 106 patients (89%; Group N), and transient type II endoleak from IMA in 10 patients (8.3%; Group T). CT showed persistent type II endoleak from IMA in 4 patients (3.3%; Group P) and three of them underwent reintervention. Univariate Cox-Mantel test analysis indicated that stenosis (p = 0.0003) and thrombus (p = 0.043) in IMA orifice were significant factors for persistent type II endoleak. The ratios of patients with proximal IMA more than 2.5 mm diameter in Groups N, Y, and P were 26/106 (24%), 5/10 (50%) and 4/4 (100%), respectively. Conclusion: Indicators for embolization of IMA prior to EVAR for the prevention of type II endoleak appear to be: (1) more than 2.5 mm in diameter and (2) no stenosis due to calcification or mural thrombus in IMA orifice.

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Section: Introductionmentioning

confidence: 99%

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

Fukuda

Matsuda

Sanda

et al. 2014

Annals of Vascular Diseases

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“…It would be of extreme clinical relevance to be able to identify a high-risk group for the development of a type 2 endoleak that is persistent or requires treatment on the basis of the initial computed tomography (CT) scan. Preoperative embolization of aortic side branches could then be performed in these patients to counteract the development of a type 2 endoleak [16,17]. The size of the intra-aneurysmatic thrombus volume [18,19] and the number of aortic side branches [20 -22] on the basis of the initial CT scan were identified as prognostic factors in previous studies.…”

mentioning

confidence: 99%

Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

Löwenthal

Herzog

Rogits

et al. 2014

Fortschr Röntgenstr

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Purpose: An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR). Materials and Methods: Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n?=?80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n?=?50). Statistical analysis comprised a univariate and multivariate analysis. Results: Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4???3.8?mm; HRG 23.6???2.5?mm; p?=?0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7???18.0?%; HRG 25.3???17.5?%; p?=?0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3?%; HRG 92.0?%; p?=?0.003) and their diameter (LRG 3.3???0.7?mm; HRG 3.8???0.9?mm; p?=?0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7???1.4; HRG 3.6???1.2; univariate: p?=?0.01; multivariate: p?=?0.006) as well as their diameter (LRG 2.1???0.4?mm; HRG 2.4???0.4?mm; univariate: p?

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“…Guntner et al concluded that there was a significantly higher incidence of T2Ls in patients with greater cross sectional area of the IMA ostium at the aortic root [23]. Knowledge of this collateralization between the SMA and IMA in T2Ls has guided the surgical approach of coil embolization in successfully preventing and treating this complication ( Figure 1B) [24,25]. Although there were only 2 patients in this study whose T2Ls demonstrated this type of collateralization, both were successfully treated with coil embolization.…”

Section: Journal Of Vascular and Endovascular Surgery Issn 2573-4482mentioning

confidence: 81%

The Natural History of Type 2 Endoleaks after EVAR Justifies Conservative Management

Ajalata¹,

Williamsa²,

Wilsona³

2017

J Vasc Endovasc Surg

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Objective: Management of type 2 endoleaks (T2Ls) after endovascular aneurysm repair (EVAR) has been controversial. Some advocate for conservative management, while others believe that intervention is indicated. This study investigated the natural history of T2Ls in order to derive direction in management. Methods:Patients who had EVAR at the Long Beach VA were retrospectively identified and computerized tomographic angiography (CTA) was independently reviewed by a radiologist and a vascular surgeon. T2Ls were analyzed for the following outcomes: rupture, duration of endoleak, spontaneous resolution, changes in the size of the aneurysm sac, and reintervention rates. Results:Of the 160 patients who had completed required followup to date (mean 3 years) after EVAR, 39 patients (24.4%) were identified as having a T2L on CTA imaging. 6 of these 39 patients (15.4%) required repair due to aneurysm sac growth >1 cm. Two (5.13%) were repaired with an open procedure and 4 (10.3%) with an endovascular approach. Of these 6 aneurysm leaks requiring repair, 4 (66.7%) had a simultaneous endoleak (types 1 or 3) in addition to the identified T2L. Spontaneous resolution of T2Ls occurred in 16 (41.0%) patients. Conclusions:Overall, we found that 85% of patients who had T2Ls did not require intervention after a mean follow up time of 3 years. The association of a type 1 or 3 endoleak with a T2L was more likely to require correction due to aneurysm expansion >1 cm, thus T2Ls associated with another type of endoleak require more aggressive management.

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Inferior Mesenteric Artery Embolization before Endovascular Aneurysm Repair: Technique and Initial Results

Cited by 86 publications

References 20 publications

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

The Natural History of Type 2 Endoleaks after EVAR Justifies Conservative Management

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