Outcomes of endovascular aneurysm repair with contemporary volume-dependent sac embolization in patients at risk for type II endoleak

Piazza, Michele; Squizzato, Francesco; Zavatta, Marco; Menegolo, Mirko; Ricotta, Joseph J.; Lepidi, Sandro; Grego, Franco; Antonello, Michele

doi:10.1016/j.jvs.2015.08.049

Cited by 64 publications

(63 citation statements)

References 21 publications

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“…11,12,17 Moreover, some reports have suggested that sac embolization during EVAR reduces ELII. 18,19 However, there is currently no strong evidence identifying which patients will benefit the most from preventive branch embolization to avoid ELII. 20 Target and routine embolization of side branches would be unnecessary and time consuming, considering the incidence of ELII and adverse events.…”

Section: Discussionmentioning

confidence: 99%

Identification of Anatomical Risk Factors for Type II Endoleak to Guide Selective Inferior Mesenteric Artery Embolization

Samura

Morikage

Mizoguchi

et al. 2018

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Identification of Anatomical Risk Factors for Type II Endoleak to Guide Selective Inferior Mesenteric Artery Embolization

Samura

Morikage

Mizoguchi

et al. 2018

Annals of Vascular Surgery

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“…When we compare the preventive sac embolization only (coils + glue) with selective sac branch embolization we can confirm that the selective approach is more efficient and has fewer artifacts and embolization materials. When we compare longer clinical outcomes, we can confirm there is no statistical evidence that sac preventive embolization has long-term efficiency as a technique to prevent EL2 [21,22]. It is recommended to embolize IMA and LA before SG deployment when the lumen diameter is more than 2-3 mm or if the number of patent LAs is more than 3.…”

Section: Discussionmentioning

confidence: 88%

“…This technique can have side effects regarding sac and neck dilatation, and expansion in the sac can lead to misplacement of the SG and further complications [20]. Aneurysm sac embolization [21,22] during the EVAR procedure using coils and glue can decrease the rise of endoleak, reduce sac volume, and improve its shrinkage. This method was described with a lower rate of reintervention due to EL2, but statistically, there was no clear outcome to confirm this technique as the best solution for prevention.…”

Section: Prevention Of El2mentioning

confidence: 99%

Treatment of the Progressive Endoleak Type 2 After EVAR

Dobeš¹

2019

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice

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An endoleak type 2 (EL2) is a relatively frequent event after an EVAR but 30-35% of EL2 can become progressive, which can cause a loss in the important sealing zone of the stent graft. Diagnosis is made by three-phase CT angiogram or by contrast-enhanced duplex scan. EL2 should be treated if the aortic sac grows more than 5 mm in 6 months time. The first suitable treatment is the endovascular approach with embolization of the inferior mesenteric artery (IMA) or lumbar arteries. Paravertebral puncture, under CT navigation to embolize the lumbar artery or a part of the aortic sac with the EL2, is another alternative. If the endovascular treatment is not successful in 2-3 times, we should consider a surgical approach. The operative approach can be a laparoscopic or an open operation: the laparoscopic approach allows us to clip the IMA and lumbar arteries. The open surgery involves laparotomy, ligation of the IMA, and endoaneurysmorrhaphy (suture of lumbar artery origins from inside) and then the suture of the aortic sac tightly around the stent graft in situ. The aortic occlusion balloon should be inserted below the renal arteries prior to open surgery. The surgical procedures have good outcomes and should be considered when the endovascular treatment is unsuccessful.

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“…15,16 However, adverse events, such as colonic infarction and death that are related to the embolization of the aortic branches, were also reported. 17,18 Additional costs and these risks prevent pre-EVAR embolization from being a standard procedure in most vascular centers. Considering that most T2EL vessels stop flowing spontaneously, selective embolization of the T2EL vessels responsible for enlarging sacs as a prophylactic procedure is desirable, if possible.…”

Section: Discussionmentioning

confidence: 99%

Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis

Katahashi

Sano

Takehara

et al. 2019

Journal of Vascular Surgery

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Objective: The objective of this study was to investigate the hemodynamic parameters of type II endoleaks (T2ELs) to predict sac expansion using four-dimensional flow-sensitive magnetic resonance imaging (4D-flow MRI) analysis. Methods: Patients who underwent endovascular aneurysm repair (EVAR) and were diagnosed with a T2EL were included in the study. Using 4D-flow MRI at 7 days, the peak flow velocity and amplitude of dynamics of blood flow per minute were measured in each T2EL vessel. The peak flow velocity was defined as the maximum of the absolute value of the blood flow velocity. The amplitude of dynamics of blood flow in the tributary arteries was defined as the sum of the absolute values of the inflow and outflow volume in each vessel. The amplitude of dynamics of blood flow in the tributary arteries per sac was calculated in each sac. The aneurysm sac diameter was measured by computed tomography (CT) at 1 year. The patients were divided into two groups according to the presence or absence of sac expansion. Results: Of 155 patients who underwent EVAR, both CT angiography and 4D-flow MRI were performed in 107 patients at 7 days after EVAR. Among them, 39 (36.4%) were found to have a T2EL, of whom 28 were re-evaluated with CT angiography and 4D-flow at 1 year; 7 patients had expanding sacs (expanding group), whereas 21 had nonexpanding sacs (not-expanding group). At 7 days, 28 patients had 80 T2EL vessels detected by 4D-flow MRI, of which 39 vessels (48.8%) had stopped flowing at 1 year (transient vessels); 41 vessels (51.3%) had sustained flow (persistent vessels). The persistent vessels had significantly larger peak flow velocity and amplitude of dynamics of blood flow. The comprehensive analysis of T2EL vessels per sac identified that the amplitude of dynamics of blood flow in the tributary arteries per sac was significantly higher in the expanding group than in the not-expanding group. A receiver operating characteristic curve analysis revealed that the sensitivity and specificity of sac enlargement at a cutoff value of 3750 mm 3 /min were 85.7% and 76.2%, respectively. Conclusions: The fate of aneurysm sacs with T2ELs after EVAR has remained difficult to predict. A comprehensive analysis of concurrent multiple T2EL vessels using 4D-flow MRI analysis may enable prediction of the sac expansion after EVAR.

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Outcomes of endovascular aneurysm repair with contemporary volume-dependent sac embolization in patients at risk for type II endoleak

Cited by 64 publications

References 21 publications

Identification of Anatomical Risk Factors for Type II Endoleak to Guide Selective Inferior Mesenteric Artery Embolization

Identification of Anatomical Risk Factors for Type II Endoleak to Guide Selective Inferior Mesenteric Artery Embolization

Treatment of the Progressive Endoleak Type 2 After EVAR

Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis

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