Preoperative Inferior Mesenteric Artery Embolization is a Cost-effective Technique that May Reduce the Rate of Aneurysm Sac Diameter Enlargement and Reintervention After EVAR

Vaillant, Michael; Barral, Pierre-Antoine; Mancini, Julien; Masi, Mariangela De; Bal, Laurence; Piquet, Philippe; Gaudry, Marine

doi:10.1016/j.avsg.2019.03.012

Cited by 16 publications

(7 citation statements)

References 30 publications

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“…Today, the role of IMA in sac shrinkage remains controversial. Some authors have recommended preoperative IMA embolization to promote shrinkage [ 37 , 38 ]. To date, no study has shown that IMA patency is linked to the absence of sac shrinkage, and the benefice of preoperative embolization remains unproven.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Consequences of Sac Shrinkage after Endovascular Infrarenal Aortic Aneurysm Repair

Vedani

Petitprez

Weinz

et al. 2022

JCM

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Background: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). We evaluated the impact of sac shrinkage on secondary interventions, on survival and its association with endoleaks, and on compliance with instructions for use (IFU). Methods: This observational retrospective study was conducted on all consecutive patients receiving EVAR for an infrarenal abdominal aortic aneurysm (AAA) using exclusively Endurant II/IIs endograft from 2014 to 2018. Sixty patients were entered in the study. Aneurysm sac shrinkage was defined as decrease ≥5 mm of the maximum aortic diameter. Univariate methods and Kaplan–Meier plots assessed the potential impact of shrinkage. Results: Twenty-six patients (43.3%) experienced shrinkage at one year, and thirty-four (56.7%) had no shrinkage. Shrinkage was not significantly associated with any demographics or morbidity, except hypertension (p = 0.01). No aneurysm characteristics were associated with shrinkage. Non-compliance with instructions for use (IFU) in 13 patients (21.6%) was not associated with shrinkage. Three years after EVAR, freedom from secondary intervention was 85 ± 2% for the entire series, 92.3 ± 5.0% for the shrinkage group and 83.3 ± 9% for the no-shrinkage group (Logrank: p = 0.49). Survival at 3 years was not significantly different between the two groups (85.9 ± 7.0% vs. 79.0 ± 9.0%, Logrank; p = 0.59). Strict compliance with IFU was associated with less reinterventions at 3 years (92.1 ± 5.9% vs. 73.8 ± 15%, Logrank: p = 0.03). Similarly, survival at 3 years did not significantly differ between strict compliance with IFU and non-compliance (81.8 ± 7.0% vs. 78.6 ± 13.0%, Logrank; p = 0.32). Conclusion: This study suggests that shrinkage ≥5 mm at 1-year is not significantly associated with a better survival rate or a lower risk of secondary intervention than no-shrinkage. In this series, the risk of secondary intervention regardless of shrinkage seems to be linked more to non-compliance with IFU. Considering the small number of patients, these results must be confirmed by extensive prospective studies.

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Section: Discussionmentioning

confidence: 99%

Predictors and Consequences of Sac Shrinkage after Endovascular Infrarenal Aortic Aneurysm Repair

Vedani

Petitprez

Weinz

et al. 2022

JCM

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“…20 IMA embolization has been demonstrated to be cost neutral due to prevention of repeat procedures, and can lead to a reduction in overall aneurysm sac diameter compared with those patients who do not receive IMA embolization. 21 Coils are a commonly used embolic agent for this procedure. 17,22 IMA embolization is generally considered to be a safe procedure, with most patients having no evidence of complications.…”

Section: Strategies and Techniques To Prevent Development Of Type 2 Ementioning

confidence: 99%

Predictive Factors and Strategies to Prevent the Development of Type 2 Endoleaks following Endovascular Aneurysm Repair

Voutsinas

Kim

Lookstein

2020

Semin intervent Radiol

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Type 2 endoleaks are a potential complication of endovascular aortic repair for abdominal aortic aneurysms. They are caused by vessels that have been excluded from the aorta lumen, but may still fill the aneurysm sac due to collateral filling. Type 2 endoleaks may lead to increased morbidity and need for additional procedures. Being able to identify patients at risk for Type 2 endoleaks and prevent them is important for any physician who is performing endovascular aortic repair.

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“…In many reports, preemptive IMA embolization has been associated with a decrease in T2ELs and a decrease in T2 EL-related aneurysm size [50][51][52][53][54]. However, Chew et al [55] reported that the significant difference disappeared after 6 months and LA patency was a significant risk factor for persistent T2ELs.…”

Section: Preemptive Branch Embolizationmentioning

confidence: 99%

Recent Update of Endovascular Type 2 Endoleak Management

Katada

2020

Interventional Radiology

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EVAR has been used clinically for almost three decades, and it has been widely applied in clinical practice and has been applied to difficult cases as devices and techniques have evolved. Although the major advantage of EVAR is its lower perioperative mortality, compared with open surgery, late-onset complications such as endoleaks have become major issues, requiring lifelong follow-up after EVAR. The clinical guidelines have been updated, and many systematic reviews/meta-analyses and multi-center registries have been published; surgeons must keep up-to-date regarding these changes. In this review, the author reviews evidence on the recent update of the type 2 endoleak management.

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Preoperative Inferior Mesenteric Artery Embolization is a Cost-effective Technique that May Reduce the Rate of Aneurysm Sac Diameter Enlargement and Reintervention After EVAR

Cited by 16 publications

References 30 publications

Predictors and Consequences of Sac Shrinkage after Endovascular Infrarenal Aortic Aneurysm Repair

Predictors and Consequences of Sac Shrinkage after Endovascular Infrarenal Aortic Aneurysm Repair

Predictive Factors and Strategies to Prevent the Development of Type 2 Endoleaks following Endovascular Aneurysm Repair

Recent Update of Endovascular Type 2 Endoleak Management

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