Endovascular Aneurysm Repair With Inferior Mesenteric Artery Embolization for Preventing Type II Endoleak

Abstract

Objective: This study aimed to evaluate the effect of inferior mesenteric artery (IMA) embolization during endovascular aneurysm repair (EVAR) in patients at high risk of type II endoleak (T2EL) in randomized controlled trial (RCT). Summary Background Data: Several studies have demonstrated a reduction of T2EL by IMA embolization before EVAR. However, there have been no RCT confirming the efficacy of IMA embolization. Methods: Patients scheduled for elective EVAR between April 2014 and March 2018 were eligible. Patients at high risk of T2EL (IMA patency with IMA ≥3 mm, LAs ≥2 mm, or an aortoiliac-type aneurysm) were prospectively randomized to receive EVAR with or without IMA embolization. The primary endpoint was occurrence of T2EL during follow-up. Secondary endpoints included aneurysmal sac changes, adverse events from IMA embolization, and reintervention rate due to T2EL. This trial is registered with the University Hospital Medical Information Network, number UMIN000022147. Results: One hundred thirteen patients had high risk and 106 were randomized. In the intention-to-treat analysis, the incidence of T2EL was significantly lower in the embolization group [24.5% vs 49.1%; P = 0.009, absolute risk reduction = 24.5%; 95% confidence interval (CI), 6.2–40.5, number needed to treat = 4.1; 95% CI, 2.5–16.1]. The aneurysmal sac shrunk significantly more in the embolization group (−5.7 ± 7.3 mm vs −2.8 ± 6.6 mm; P = 0.037), and the incidence of aneurysmal sac growth related to T2EL was significantly lower in the embolization group (3.8% vs 17.0%; P = 0.030). There were no complications related to IMA embolization or reinterventions associated with T2EL. Conclusions: Our results demonstrated the effectiveness of IMA embolization during EVAR in high-risk patients for the prevention of T2EL, which is suggested for avoiding aneurysmal sac enlargement related to T2EL.

Outcomes of Type II Endoleak Treatment Using Ethylene Vinyl Alcohol Copolymer (OnyxTM)

“…Coil embolization of patent aortic side branches at time of EVAR to prevent T2ELs has also been described but has not yet become a mainstay prevention strategy. [10][11][12] Endovascular techniques have emerged as the preferred treatment modality for treatment of T2ELs, most often utilizing embolization via a trans-arterial or trans-lumbar approach. Regardless of the approach, endoleak treatment with coil embolization alone is associated with a high rate of reintervention and therefore, many investigators have refined their technique to incorporate ethylene vinyl alcohol copolymer or Onyx™ embolization.…”

A Case of Thrombosed Inferior Mesenteric Artery Aneurysm Concomitant with Abdominal Aortic Aneurysm Treated by Endovascular Aneurysm Repair

“…We expected the IMAA to shrink secondarily with the decrease of the inner pressure of AAA by EVAR; and we could achieve a good result. When IMA is patent, the proximal site should be occluded, or the chimney technique 3) can prevent type II endoleak from IMA, 8) keeping the blood flow to the intestine. The aneurysm wall was enhanced in CT just before EVAR.…”

Predictive Factor of the Possibility for Aortic Side Branches Coil Embolization during Endovascular Abdominal Aortic Aneurysm Repair

“…19) Therefore, a patent IMA is thought to be an important cause of T2EL. Many studies 10,16,[20][21][22][23][24][25][26][27] have reported preoperative or intraoperative embolization attempts for the IMA and the success rate has been reported as ranged from 88.7%-100%. In these reports, embolization was attempted for 457 IMAs in total, with a remarkably high success rate of 95.8% has been reported.…”