Two-Stage Endovascular Aneurysm Repair with Preemptive Embolization: A Retrospective Study

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Technology

Background:

• Type II endoleak (T2EL) is a frequent complication following endovascular aneurysm repair (EVAR).
• Retrograde perfusion from the inferior mesenteric artery (IMA) and lumbar arteries (LAs) can lead to adverse events, including sac enlargement and rupture.
• Preemptive embolization of these arteries is a strategy to prevent T2EL and reduce aneurysm sac size.

Purpose of the Study:

• To evaluate the efficacy of a two-stage EVAR approach.
• To assess the impact of separating embolization and EVAR procedures on T2EL occurrence.
• To compare operative time, contrast media use, and radiation exposure between simultaneous and two-stage procedures.

Main Methods:

• Retrospective analysis of 114 EVAR cases (January 2019 - December 2022).
• Patients were divided into a simultaneous group (embolization and EVAR combined, n=49) and a two-stage group (embolization and EVAR on separate days, n=30).
• Primary endpoints included T2EL occurrence and IMA/LA embolization rates.

Main Results:

• No T2EL occurred in the two-stage group (35 months follow-up) versus 8.2% in the simultaneous group (28 months follow-up).
• Total operative time was reduced in the two-stage group (304 min) compared to the simultaneous group (340 min).
• The two-stage group showed decreased contrast media use and radiation exposure, with significantly higher LA embolization rates (87.9% vs. 74.3%).

Conclusions:

• A two-stage EVAR strategy with preemptive IMA and LA embolization is effective in preventing T2EL.
• This approach leads to reduced overall operative time, contrast media consumption, and radiation exposure.
• The two-stage method demonstrates improved technical outcomes, particularly in lumbar artery embolization rates.