Makoto Samura
Nationality
Japan
Current Position
.Medical staff, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine
.Visiting Instructor, Division of Vascular Surgery, Stanford University School of Medicine
Organization
Yamaguchi University Graduate School of Medicine Stanford University School of Medicine
Abdominal Aorta & Aortic iliac Session

Topic: Endovascular Aneurysm Repair with Inferior Mesenteric Artery Embolization for Preventing Type II Endoleak -A Prospective Randomized Controlled Trial

Abstract

Objective: This study aimed to evaluate the effect of inferior mesenteric artery (IMA) embolization during endovascular aneurysm repair (EVAR) in patients at high risk of type II endoleak (T2EL) in randomized controlled trial (RCT). Methods: Patients scheduled for elective EVAR between April 2014 and March 2018 were eligible. Patients at high risk of T2EL (IMA patency with IMA ≥3 mm, LAs ≥2 mm, or an aortoiliac-type aneurysm) were prospectively randomized to receive EVAR with or without IMA embolization. The primary endpoint was occurrence of T2EL during follow-up. Secondary endpoints included aneurysmal sac changes, adverse events from IMA embolization, and reintervention rate due to T2EL. Results: A total of 106 patients were randomized to the embolization group (group A, n = 53) or the nonembolization group (group B, n = 53). The incidence of T2EL was significantly lower in the embolization group (23.9% in group A vs. 53.8% in group B; P =0.004) during thefollow-up period (50.2 ± 21.9 months in group A and 52.9 ± 23.1 months in group B). Sac diameter changes, the incidence of aneurysmal sac growth (≥5 mm) related to T2EL, and freedom from sac enlargement (≥5 mm) related to T2EL at 5 years were −6.5 ± 8.9 mm vs. −1.1 ± 13.1 mm, 6.5% vs. 25.0%, and 97.5% vs. 72.0% in groups A and B, respectively (P = 0.025; P = 0.015; P = 0.018), which show that both shrinkage of aneurysm and freedom from sac enlargement are significantly higher in group A. Conclusions: Our results demonstrated the effectiveness of IMA embolization during EVAR in high-risk patients for the prevention of T2EL, which is suggested for avoiding aneurysmal sac enlargement related to T2EL.

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