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Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair.

Suvi Väärämäki1, Herman Viitala2, Sani Laukontaus2

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European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
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Routine embolisation of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) does not improve outcomes. This study found no significant benefit in re-intervention rates for type II endoleaks when comparing routine IMA embolisation to leaving the IMA untouched.

Keywords:
AAAEVAREmbolisationIMAProphylacticRoutine

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Endovascular Repair

Background:

  • Type II endoleaks are common after endovascular aneurysm repair (EVAR).
  • A patent inferior mesenteric artery (IMA) is a known risk factor for type II endoleaks.
  • The impact of routine IMA embolisation prior to EVAR on patient outcomes remains unclear.

Purpose of the Study:

  • To compare the outcomes of routine attempted IMA embolisation before EVAR versus leaving the IMA untreated.
  • To evaluate the effect of IMA management strategies on re-intervention rates and other EVAR-related complications.

Main Methods:

  • Retrospective review of patients undergoing EVAR between 2005-2015 in two centers.
  • Center A: routine attempted IMA embolisation; Center B: IMA left untouched.
  • Primary endpoints: re-intervention for type II endoleaks and late IMA embolisation. Secondary endpoints: EVAR re-intervention, sac enlargement, rupture, and conversion rates.

Main Results:

  • No significant difference in re-intervention rates for type II endoleaks between strategies (12.9% vs 10.4%, p=0.29).
  • Similar EVAR-related re-intervention rates (24.1% vs 24.6%, p=0.93), sac enlargement (20.3% vs 19.6%, p=0.82), rupture (2.5% vs 2.1%, p=0.69), and conversion rates (1.0% vs 1.5%, p=0.40).
  • A statistically significant difference was observed in late IMA embolisation rates (2.0% vs 4.7%, p=0.039), favoring routine embolisation.

Conclusions:

  • Routine IMA embolisation prior to EVAR does not appear to offer significant clinical benefits.
  • The strategy of routinely embolising the IMA before EVAR should be reconsidered.
  • Management of the IMA should be individualized based on patient-specific factors rather than routine embolisation.