Selective Intra-procedural AAA sac Embolization During EVAR Reduces the Rate of Type II Endoleak

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Aneurysm Repair (EVAR)

Background:

• Persistent type II endoleak (ELIIp) after EVAR is often predicted by pre-treatment factors like >=6 efferent patent vessels or AAA thrombus volume ratio <40%.
• Managing ELIIp is crucial for long-term EVAR success and patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of intra-procedural AAA sac embolization in preventing ELIIp.
• To assess the safety and effectiveness of this technique in patients with pre-operative morphological risk factors (p-MRF) for ELIIp.

Main Methods:

• Retrospective comparison of 26 patients undergoing EVAR with sac embolization (Group A) versus 44 patients with EVAR alone (Group B).
• Both groups had similar p-MRF.
• ELIIp was assessed via ultrasound at 0, 6, and 12 months. Multivariate logistic regression analyzed factors associated with ELIIp.

Main Results:

• Sac embolization significantly reduced ELIIp rates at discharge (8/26 vs. 33/44, p < .001) and at 6-12 months (p = .001 to p < .001).
• Intra-procedural sac embolization was the sole independent predictor of freedom from ELIIp at 6 and 12 months (p = .007 and p < .001, respectively).
• No significant difference in AAA sac shrinkage was noted between groups; re-intervention rates were 0% in both.

Conclusions:

• Selective intra-procedural AAA sac embolization is a safe and effective method for reducing ELIIp in EVAR patients with p-MRF.
• Further long-term studies are needed to confirm these findings.