Is Inferior Mesenteric Artery Embolization Indicated Prior to Endovascular Repair of Abdominal Aortic Aneurysm?

Abstract

Type II endoleak is a common condition occurring after endovascular repair of abdominal aortic aneurysms (EVAR), and may result in aneurysm sac growth and/or rupture in a small number of patients. A prophylactic strategy of inferior mesenteric artery (IMA) embolization before EVAR has been advocated, however, the benefits of this strategy are controversial. A clinical vignette allows the authors to summarize the available data about this issue and discuss the possible benefits and risks of prophylactic IMA embolization before EVAR. The authors performed a meta-analysis of available data which showed that the pooled rate of type II endoleak after IMA embolization was 19.9% (95% CI 3.4-34.7%, I2 93%) whereas it was 41.4% (95% CI 30.4-52.3%, I2 76%) in patients without IMA embolization (5 studies including 596 patients: p < .0001, OR 0.369, 95% CI 0.22-0.61, I2 27%). Since treatment for type II endoleaks is needed in less than 20% of cases and this complication can be treated successfully in 60-70% of cases resulting in an aneurysm rupture risk of 0.9%, these data indicate that embolization of patent IMA may be of no benefit in patients undergoing EVAR.

Natural History, Diagnosis, and Management of Type II Endoleaks after Endovascular Aortic Repair: Review and Update

“…118e120 Even if preventive interventions have been shown to cause a reduction in the incidence of T2ELs, whether the decreased rate of T2ELs actually translates in clinical benefits remains controversial. 121e123 Indeed, even after successful IMA embolization 124,125 or in patients with chronic occluded IMA, 126 T2ELs can still develop from LAs and result in sac enlargement. Also, more aggressive approaches may cause overtreatment in those patients who will never develop T2EL-related complications, can delay the time to definitive AAA management, and the cost-effectiveness has not been definitely demonstrated.…”

Innovative Procedure for Inferior Mesenteric Artery Embolization Using the Amplatzer Vascular Plug 4 during Endovascular Aneurysm Repair

“…A recently published meta-analysis reported on the reduction of type II endoleaks. 15 This previous meta-analysis found that IMA embolization is associated with a significantly low risk of type II endoleaks; however, the studies assessed were all retrospective trials. After the completion of the randomized prospective study on this topic that is currently underway, we will have a better understanding of the effectiveness of this procedure.…”

Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Comprehensive Review

“…Although the effectiveness of preventive embolization of aortic branches is controversial (51), patients with inferior mesenteric artery diameter > 3.0 mm or lumbar artery diameter > 2.0 mm can be the candidates for undergoing preventive embolization (Fig. 5) (52).…”