Value of Preliminary Selective Lumbar and Inferior Mesenteric Artery Embolization to Prevent Type II Endoleaks After Endovascular Aneurysm Repair

Abstract

a 3DAM since 2018. End points were mortality, freedom from endoleak, target vessel patency, and reintervention.Results: There were 7 patients (36.8%) who were treated by PMSGs planned by centerline reconstruction (3 PRAs, 3 extent IV and 1 extent III TAAAs) and 12 patients (63.2%) who received PMSGs based on 3DAMs (5 PRAs, 7 extent IV TAAAs). Six patients presented with contained aortic rupture, and 13 patients were treated for symptomatic aortic aneurysm. Mean aortic diameter was 72 6 10 mm. The choice of endograft to be fenestrated was Valiant Captivia Closed Web (Medtronic, Santa Rosa, Calif), except for one patient. Sixteen (84.2%) endografts were manufactured with four fenestrations. The time of manufacturing of the PMSG based on a 3DAM was significantly shorter (109.6 6 10.7 minutes vs 154.6 6 12.7 minutes; P < .0001). Technical success was 100%. A total of 71 renovisceral branch vessels were targeted with fenestrations. The mean length of hospital stay was 17.3 6 10.4 days. The 30-day mortality was 0%. Two patients developed reversible spinal cord injury. Mean follow-up was 14.4 6 17.9 months. During follow-up, one non-aneurysmrelated death occurred, and two successful reinterventions were performed: one to re-establish renal patency and one to treat a type IC endoleak.Conclusions: PMSGs for the urgent treatment of juxtarenal aneurysms and TAAAs in high-risk patients unsuitable for commercially available stent grafts are feasible and safe. 3DAMs significantly decrease the manufacturing time of PMSGs.