Pre-emptive Aortic Side Branch Embolization during Endovascular Aneurysm Repair Using the Excluder Stent-Graft...

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Repair

Background:

• Type 2 endoleaks (EL2) are a common complication after endovascular aneurysm repair (EVAR).
• Aortic side branches (ASBs) are a frequent source of EL2, potentially leading to aneurysm sac enlargement and reintervention.
• Pre-emptive strategies are needed to mitigate EL2 risk before EVAR.

Purpose of the Study:

• To evaluate the safety and effectiveness of pre-emptive transcatheter arterial embolization (P-TAE) for ASBs.
• To prevent Type 2 endoleaks (EL2) in patients undergoing EVAR with the Excluder stent-graft system.
• To assess the impact of P-TAE on aneurysmal sac dynamics and reintervention rates.

Main Methods:

• Prospective, multicenter study involving 80 patients undergoing EVAR with the Excluder stent-graft.
• Pre-emptive embolization of patent ASBs was performed prior to EVAR.
• Contrast-enhanced CT scans were used for follow-up at 1 and 6 months post-EVAR to assess EL2 incidence and sac diameter changes.

Main Results:

• P-TAE was successfully performed in all patients with a high rate of coil embolization (81.6%) of ASBs.
• The incidence of EL2 at 6 months was 25.7% (18 of 70 patients).
• Aneurysmal sac shrinkage (≥5 mm) was observed in 30.0% at 6 months and 40.9% at 12 months, with only one reintervention for EL2 within one year.

Conclusions:

• Pre-emptive transcatheter arterial embolization (P-TAE) for aortic side branches is a safe and effective adjunct to EVAR.
• P-TAE contributes to early aneurysmal sac shrinkage.
• This approach reduces the need for reintervention due to Type 2 endoleaks within one year post-EVAR.