Selective Inferior Mesenteric Artery Embolization during Endovascular Abdominal Aortic Aneurysm Repair to Prevent Type II Endoleak.

PURPOSE

The purpose of this study was to evaluate the efficacy of simultaneous IMA (s-IMA) embolization during the endovascular abdominal aortic aneurysm repair (EVAR).

MATERIALS AND METHOD

From July 2007 to January 2011, 189 patients in the no embolization (NE) group underwent EVAR without the indication for s-IMA embolization. Since February 2011 to April 2014, 143 patients have undergone EVAR. Among these patients, 26 patients underwent s-IMA embolism under a predefined indication and constituted the simultaneous embolization (SE) group. The indications for s-IMA embolization were defined by preoperative computed tomography (CT) findings, as follows: (1) the diameter was greater than 2.5 mm and (2) no stenosis due to thrombus or calcification at its orifice.

RESULTS

The incidence of a type II endoleak from the IMA was 3.4% (5/143) in the SE group patients and 13.2% (25/189) in the NE group patients (p = 0.013), and the incidence of a type II endoleak from all branches (i.e., IMA, lumbar, medial sacral arteries) was 15.4% (22/143) in the SE group patients and 32.3% (61/189) in the NE group patients (p = 0.0003). During the follow-up period (range, 6-72 months; mean: 28 months), the reintervention rate for a type II endoleak from the IMA and/or other branches was 9.5% (18/189) in the NE group and 0.6% (1/143) in the SE group (p = 0.0001).

CONCLUSION

In selected patients, performing an s-IMA embolization, based on CT findings, decreased the incidence of a type II endoleak and reintervention from the IMA and from all branches.