Midterm Outcomes of Preemptive Side Branch Embolization Aimed for Total Branch Embolization During Endovascular...

We performed preemptive side branch embolization (PBE) during endovascular aneurysm repair (EVAR) to prevent type 2 endoleak (T2EL). Our aggressive PBE (A-PBE) strategy aims to embolize all patent side branches of abdominal aortic aneurysm (AAA) identified on preoperative computed tomography (CT). This study evaluated midterm clinical outcomes for that strategy.

Participants comprised 140 of 163 patients who underwent primary EVAR between 2015 and 2024. A total of 33 patients received A-PBE based on age, comorbidities, and activities of daily living (A-PBE group). The remaining 107 patients were assigned to the O group. Outcomes examined were changes in aneurysm sac diameter, reintervention rates, and T2EL incidence.

The mean follow-up was 3.0 ± 2.3 years for the A-PBE group and 4.0 ± 2.6 years for the O group. The incidence of sac shrinkage was significantly higher in the A-PBE group (63.6% vs. 37.4%, P = 0.0078). The incidences of sac enlargement and T2EL were significantly lower in the A-PBE group (6.1% vs. 28.0%, P = 0.0086; 15.2% vs. 36.4%, P = 0.031, respectively). Sixteen patients in the O group (15.0%) required reintervention for sac enlargement, compared to none in the A-PBE group. Total embolization was achieved in 57.6% of A-PBE cases, with only one sac enlargement and T2EL due to incomplete embolization. Operative and fluoroscopy times and contrast agent usage were higher in the A-PBE group, but no postoperative complications or new dialysis occurred.

A-PBE effectively promotes sac shrinkage and reduces T2EL and sac enlargement, potentially improving long-term EVAR outcomes in selected patients.