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Abstract

Purpose

To report our results of endovascular aneurysm repair (EVAR) over a 10-year period using systematic preoperative collateral artery embolization.

Methods

From 1999 until 2009, 124 patients (117 men; mean age 70.8 years) with abdominal aortic aneurysm (AAA) underwent embolization of patent lumbar and/or inferior mesenteric arteries prior to elective EVAR procedures. Embolization was systematically attempted and, whenever possible, performed using microcoils and a coaxial technique. Follow-up included computed tomography and/or magnetic resonance imaging and abdominal radiography.

Results

The technical success for EVAR was 96% (119/124), with 4 patients dying within 30 days (3.2% perioperative mortality) and 1 type III endoleak accounting for the failures. Collateral arteries were occluded spontaneously or by embolization in 60 (48%) of 124 patients. The endoleak rate was 50.9% (74 in 61 patients), most of which were type II (19%). Over a mean clinical follow-up of 60.5±34.1 months (range 1–144), aneurysm sac dimensions decreased in 66 patients, increased in 19 patients, and were stable in 35. The endoleak rate was significantly higher in the patients with increasing sac diameter (p<0.001). Among the patients with patent collateral arteries, 38/64 (59.3%) developed 46 leaks, while 28 leaks appeared in 23 (41%) of 56 patients with collateral artery occlusion (p=0.069). The type II endoleak rate significantly differed between these two groups (47.8% vs. 3.6%, p<0.001).

Conclusion

Preoperative collateral embolization seems to be a valid method of reducing the incidence of type II endoleak, improving the long-term outcome.

Keywords

abdominal aortic aneurysm endovascular aneurysm repair stent-graft preoperative side branch embolization endoleak inferior mesenteric artery lumbar artery coil embolization mortality sac diameter aneurysm rupture outcome analysis

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References

Schwarze

Shen

Hemmerich

. Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001–2006. J Vasc Surg. 2009;50:722–729.e2.

EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365:2179–2186.

Lawrence-Brown

Sun

Semmens

. Type II endoleaks: when is intervention indicated and what is the index of suspicion for types I or III? J Endovasc Ther. 2009;16(Suppl I):I106–I118.

Ward

Cohen

Fischman

. Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol. 2013;24:49–55.

Golzarian

Valenti

. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment. Eur Radiol. 2006;16:2849–2857.

Dias

Ivancev

Resch

. Endoleaks after endovascular aneurysm repair lead to nonuniform intra-aneurysm sac pressure. J Vasc Surg. 2007;46:197–203.

Pitton

Schmenger

Düber

. Systemic pulsatile pressure in type II endoleaks after stent grafting of experimental abdominal aortic aneurysms. Cardiovasc Intervent Radiol. 2003;26:283–289.

Schlösser

Gusberg

Dardik

. Aneurysm rupture after EVAR: can the ultimate failure be predicted? Eur J Vasc Endovasc Surg. 2008;37:15–22.

Jonker

Aruny

Muhs

. Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg. 2009;22:165–171.

10.

Silverberg

Baril

Ellozy

. An 8-year experience with type II endoleaks: natural history suggests selective intervention is a safe approach. J Vasc Surg. 2006;44:453–459.

11.

Marchiori

von Ristow

Guimaraes

. Predictive factors for the development of type II endoleaks. J Endovasc Ther. 2011;18:299–305.

12.

Warrier

Miller

Bond

. Risk factors for type II endoleaks after endovascular repair of abdominal aortic aneurysms. ANZ J Surg. 2008;78:61–63.

13.

Parry

Kessel

Robertson

. Type II endoleaks: predictable, preventable, and sometimes treatable? J Vasc Surg. 2002;36:105–110.

14.

Gould

McWilliams

Edwards

. Aortic side branch embolization before endovascular aneurysm repair: incidence of type II endoleak. J Vasc Interv Radiol. 2001;12:337–341.

15.

Bonvini

Alerci

Antonucci

. Preoperative embolization of collateral side branches: a valid means to reduce type II endoleaks after endovascular AAA repair. J Endovasc Ther. 2003;10:227–232.

16.

Nevala

Biancari

Manninen

. Inferior mesenteric artery embolization before endovascular repair of an abdominal aortic aneurysm: effect on type II endoleak and aneurysm shrinkage. J Vasc Interv Radiol. 2010;21:181–185.

17.

Brown

Epstein

Manca

. The UK endovascular repair (EVAR) trials: design, methodology and progress. Eur J Vasc Endovasc Surg. 2004;27:372–381.

18.

Alerci

Oberson

Fogliata

. Prospective, intraindividual comparison of MRI versus MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms. Eur Radiol. 2009;19:1223–1231.

19.

White

May

Waugh

. Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Surg. 1998;5:305–309.

20.

Blankensteijn

de Jong

Prinssen

.; Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005;352:2398–2405.

21.

Mertens

Houthoofd

Daenens

. Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft. J Vasc Surg. 2011;54:48–57.e2.

22.

Coppi

Silingardi

Saitta

. Single-center experience with the Talent LPS endograft in patients with at least 5 years of follow-up. J Endovasc Ther. 2008;15:23–32.

23.

EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365(9478):2187–2192.

24.

Abularrage

Crawford

Conrad

. Preoperative variables predict persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg. 2010;52:19–24.

25.

El Batti

Cochennec

Roudot-Thoraval

. Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg. 2013;57:1291–1297.

26.

Nolz

Teufelsbauer

Asenbaum

. Type II endoleaks after endovascular repair of abdominal aortic aneurysms: fate of the aneurysm sac and neck changes during long-term follow-up. J Endovasc Ther. 2012;19:193–199.

27.

Conrad

Adams

Guest

. Secondary intervention after endovascular abdominal aortic aneurysm repair. Ann Surg. 2009;250:383–389.

28.

Sarac

Gibbons

Vargas

. Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg. 2012;55:33–40.

29.

Nevala

Biancari

Manninen

. Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Intervent Radiol. 2010;33:278–284.

30.

Fan

Rafferty

Geller

. Endovascular stent-graft in abdominal aortic aneurysms: the relationship between patent vessels that arise from the aneurysmal sac and early endoleak. Radiology. 2001;218:176–182.

31.

Pitton

Scheschkowski

Ring

. Ten-year follow-up of endovascular aneurysm treatment with Talent stent-grafts. Cardiovasc Intervent Radiol. 2009;32:906–917.

32.

Muthu

Maani

Plank

. Strategies to reduce the rate of type II endoleaks: routine intraoperative embolization of the inferior mesenteric artery and thrombin injection into the aneurysm sac. J Endovasc Ther. 2007;14:661–668.

33.

Sheehan

Hagino

Canby

. Type 2 endoleaks after abdominal aortic aneurysm stent grafting with systematic mesenteric and lumbar coil embolization. Ann Vasc Surg. 2006;20:458–463.

34.

Schanzer

Greenberg

Hevelone

. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation. 2011;123:2848–2855.

35.

Hogg

Morasch

Park

. Long-term sac behavior after endovascular abdominal aortic aneurysm repair with the Excluder low-permeability endoprosthesis. J Vasc Surg. 2011;53:1178–1183.

36.

Brewster

Jones

Chung

. Long-term outcomes after endovascular abdominal aortic aneurysm repair. The first decade. Ann Surg. 2006;244:426–438.

37.

Axelrod

Lookstein

Guller

. Inferior mesenteric artery embolization before endovascular aneurysm repair: technique and initial results. J Vasc Interv Radiol. 2004;15:1263–1267.

38.

Espinosa

Ribeiro Alves

Ferreira Caramalho

. A 10-year single-center prospective study of endovascular abdominal aortic aneurysm repair with the Talent stent-graft. J Endovasc Ther. 2009;16:125–135.

39.

Pitton

Schweitzer

Herber

. MRI versus helical CT for endoleak detection after endovascular aneurysm repair. AJR Am J Roentgenol. 2005;185:1275–1281.

40.

Habets

Zandvoort

Reitsma

. Magnetic resonance imaging is more sensitive than computed tomography angiography for the detection of endoleaks after endovascular abdominal aortic aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg. 2013;45:340–350.

41.

Ronsivalle

Faresin

Franz

. Aneurysm sac “thrombization” and stabilization in EVAR: a technique to reduce the risk of type II endoleak. J Endovasc Ther. 2010;17:517–524.

42.

Mehta

Sternbach

Taggert

. Long-term outcomes of secondary procedures after endovascular aneurysm repair. J Vasc Surg. 2010;52:1442–1448.

43.

Bartoli

Thevenin

Sarlon

. Secondary procedures after infrarenal abdominal aortic aneurysms endovascular repair with second-generation endografts. Ann Vasc Surg. 2012;26:166–174.

Endovascular Abdominal Aneurysm Repair and Impact of Systematic Preoperative Embolization of Collateral Arteries: Endoleak Analysis and Long-term Follow-up

Abstract

Purpose

Methods

Results

Conclusion

Keywords

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