Prospective, Randomised Two Centre Trial of Endovascular Repair of Abdominal Aortic Aneurysm With or Without Sac Embolisation

Fabre, Dominique; Mougin, Justine; Mitilian, Délphine; Cochennec, Frédéric; Alonso, Carlos Garcia; Becquemin, Jean‐Pierre; Desgranges, Pascal; Allaire, Éric; Hamdi, Sarah; Brénot, Philippe; Bourkaib, Riyad; Haulon, Stéphan

doi:10.1016/j.ejvs.2020.11.028

Cited by 28 publications

(22 citation statements)

References 24 publications

(36 reference statements)

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“…In previous studies, different centers have reported different efficacy of sac embolization due to various follow-up times. The early-term effectiveness of EVAR combined with sac embolization has been widely recognized (18,19,25,30) and confirmed by our studies. Pilon (26)and Ronsivalle ( 27)…”

Section: Discussionsupporting

confidence: 86%

“…Type II endoleak is the most common complication after EVAR. Some type II endoleaks may close or increase the diameter of the aneurysm sac and re-intervention (19). Sac embolization in EVAR is performed by developing new access on the opposite side of the delivery route of the main stent, thereby leaving the 4F contrast catheter within the AAA cavity.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of prophylactic intraoperative sac embolization in EVAR for abdominal aortic aneurysm: A meta-analysis

Chen

Zhang²,

Lei³

et al. 2023

Front. Surg.

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ObjectiveWe aimed to investigate the effectiveness and safety of prophylactic sac embolization during endovascular aneurysm repair (EVAR) in patients suffering from abdominal aortic aneurysms.MethodsWe performed a systematic literature search of PubMed, Web of Science, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, Wanfang and China Biomedical Literature Database (CBM) to identify studies evaluating the outcomes of sac embolization vs. no embolization among patients who had received EVAR. The time limit of the search was from the establishing database to July 22, 2022. Outcome measures involved the type II endoleak rate, the other endoleak rate, the reintervention rate, mortality, and operation time. Fixed (no heterogeneity) or random effects models were constructed for each outcome. The outcomes are represented as the odds ratio (OR) with a 95% confidence interval (CI).ResultsAmong the 2,622 studies screened, 13 studies involving 747 participants were included in the review. The incidence of early-term type II endoleak (OR = 0.2, 95% CI (0.13,0.31), P < 0.00001), mid-term type II endoleak (OR = 0.23, 95% CI (0.15,0.37), P < 0.00001), late-term type II endoleak (OR = 0.27, 95% CI (0.16,0.46), P < 0.00001) and reintervention (OR = 0.50, 95% CI (0.37,0.78), P = 0.002) within the sac embolization group were significantly lower than those in the non-embolization group. No significant differences were observed between the two groups were found for the other endoleak rates (OR = 0.67, 95% CI (0.34,1.32), P = 0.25), mortality (OR = 0.64, 95% CI (0.25,1.66), P = 0.36) and operation time operation (MD = 5.76, 95% CI (-8.30,19.83), P = 0.42).ConclusionsEVAR combined with sac embolization effectively reduces the incidence of type II endoleak and the reintervention rate without enhancing the operation time. Therefore, more high-quality studies are still needed for validation due to the limited amount and quality of included literature.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022365648.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of prophylactic intraoperative sac embolization in EVAR for abdominal aortic aneurysm: A meta-analysis

Chen

Zhang²,

Lei³

et al. 2023

Front. Surg.

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“…Erwartungsgemäß zeigt sich kein Effekt auf die Rate von Typ-I- und Typ-III-Endoleaks. Gleiches gilt für die präventive Embolisation des Aneurysmasacks 26 27 28 . Relevante Komplikationen sind selten, vorrangig ist in diesem Zusammenhang das Risiko einer Darmischämie nach Embolisation der A. mesenterica inferior zu nennen.…”

Section: Präventive Embolisationunclassified

Typ-II-Endoleak nach EVAR: Diagnostik, Therapie und Prävention

Kurre¹,

Kerezsy²,

Wagenschwanz³

et al. 2022

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie,

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Endovaskulär versorgte Bauchaortenaneurysmen haben im Vergleich zu operierten eine geringere Langzeitstabilität. Ursächlich dafür kann eine bleibende oder neu entstehende periprothetische Perfusion (Endoleak) mit anhaltendem Druck im Aneurysma sein. Am häufigsten sind Typ-II-Endoleaks, die durch in den Aneurysmasack mündende Gefäße unterhalten werden. Dieser Beitrag beleuchtet die wichtigsten Aspekte in Diagnostik, Therapie und Prävention.

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“…4,10 d Prospective randomized trials are needed to evaluate the benefit of selective prophylactic aortic side branch embolization and sac embolization for patients at high risk of a type II endoleak. d Two recent small, randomized trials have evaluated concomitant aneurysm sac coiling 11 and inferior mesenteric artery embolization 12 for patients deemed at high risk of type II endoleak undergoing EVAR. Early results have suggested that concomitant embolization is associated with a decrease in type II endoleak and enhanced sac volume reduction.…”

Section: Rationalementioning

confidence: 99%

Society for Vascular Surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm: Endoleak management

Rokosh

Dalman

et al. 2021

Journal of Vascular Surgery

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Prospective, Randomised Two Centre Trial of Endovascular Repair of Abdominal Aortic Aneurysm With or Without Sac Embolisation

Cited by 28 publications

References 24 publications

Efficacy and safety of prophylactic intraoperative sac embolization in EVAR for abdominal aortic aneurysm: A meta-analysis

Efficacy and safety of prophylactic intraoperative sac embolization in EVAR for abdominal aortic aneurysm: A meta-analysis

Typ-II-Endoleak nach EVAR: Diagnostik, Therapie und Prävention

Society for Vascular Surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm: Endoleak management

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