Diagnosis and Treatment of Inferior Mesenteric Arterial Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms

Abstract

Retrograde flow in the IMA is responsible for many type II endoleaks. Systemic pressures are transmitted into the aneurysm sac from the IMA. The IMA can be embolized successfully with an SMA approach in most patients.

Inferior mesenteric artery as outflow vessel in endoleaks after abdominal aortic stent-graft implantation: 36-month follow-up CT study

“…Secondary recanalization of an occluded IMA was not seen in any of the patients; thus, secondary endoleaks do not seem to be caused by a retrogradely perfused IMA. Therefore, in agreement with others [18,21], we think there is no need for preoperative embolization of the IMA.…”

“…In a recent study by Baum et al [21], 8 of 50 patients had type-II endoleaks that were attributed to retrograde flow in the IMA. The artery was embolized successfully through the SMA and left colic artery in 7 patients.…”

“…Whereas retrograde perfusion of the aneurysmal sac as a cause for an endoleak is widely accepted [3,4,6,7,14,15,17,18,21], the fact that aortic branches may provide outflow for attachment site endoleaks is rarely described [5,12,19,20]. In his early experience, Parodi decided not to treat patients who had a patent inferior artery to avoid retrograde flow into the aneurysmal sac [6].…”

Ischemic Colitis Following Transarterial Embolization for Type 2 Endoleak of EVAR: Report of a Case

“…For instance, Baum et al reported eight patients who underwent successful treatment with transarterial IMA embolization. 8) Although no residual endoleaks were detected on the 30-day postembolization CT scan, seven (87.5%) of these eight patients had recurrent type 2 endoleak. 4) On the other hand, Haulon et al presented 18 patients who underwent transarterial embolization with type 2 endoleak; wherein, the aneurysm sac shrank in 13 (72.2%) of 18 during follow-up periods and a new type 2 endoleak was diagnosed in only two (11.1%) patients.…”

“…Several treatments for type 2 endoleak were reported in the previous literature. Although surgical or laparoscopic ligation 2) and translumbar embolization [3][4][5][6] are included, transarterial chemical or coil embolization seems to be the standard option [7][8][9][10] because the treatment is less invasive. The clinical success rate of transarterial embolization varies.…”