Objective: The goal of this study was to evaluate the role of intraoperative aneurysm sac embolization during endovascular aneurysm repair (EVAR) using a standard dose of coils and fibrin glue in the prevention of type II endoleak (EII). Methods: Two groups were compared: 83 patients underwent standard EVAR during the period 2008-2009 (group A) and 79 patients underwent EVAR during the period 2010-2011 (group B). Computed tomography scans were evaluated with Osirix Pro 4.0 software to obtain aneurysm sac volume. EII rates at the first computed tomography scan follow-up, as well as midterm freedom from EII and freedom from related reintervention, were compared. Preoperative number of patent aortic side branches (inferior mesenteric artery, lumbar arteries, accessory renal arteries), sac thrombus, and sac volume were evaluated for their association with EII in the two groups using multiple logistic regressions. Results: Patient characteristics, Society for Vascular Surgery comorbidity scores (0.85 ± 0.44 vs 0.82 ± 0.46; P =.96), and operative time (185 ± 52 vs 179 ± 49; P =.92) were similar for groups A and B. The first computed tomography scan (≤3 months) revealed a significantly larger number of EIIs in group A than in group B (23% vs 10%; P =.02). Spontaneous EII resolution occurred in 65% of patients in group A and in 79% in group B (P = 1.0), whereas sac volume increased in 25% and 10% (P =.63) of cases, respectively. At 18 months (range, 6 months to 4.4 years), overall mean differences in sac volume shrinkage (27 ± 12 cm3 vs 25 ± 12 cm3; P =.19) and freedom from EII (92% vs 96%; P =.33) were similar, whereas freedom from reintervention was significantly lower in group A (93% vs 99%; P =.03) than in group B. Multivariate analysis showed preoperative aneurysm sac volume >125 cm3 to be the only independent significant predictor of EII (odds ratio, 4.0; 95% confidence interval, 1.5-10.5; P =.005). Conclusions: Although further confirmatory studies are needed, sac embolization during EVAR may be a valid approach to preventing EII and its complications during short- and midterm follow-up. More aggressive intraoperative embolization should be considered for patients with a preoperative aneurysm sac volume >125 cm3.
Piazza, M., Frigatti, P., Scrivere, P., Bonvini, S., Noventa, F., Ricotta, J. J., … Antonello, M. (2013). Role of aneurysm sac embolization during endovascular aneurysm repair in the prevention of type II endoleak-related complications. Journal of Vascular Surgery, 57(4), 934–941. https://doi.org/10.1016/j.jvs.2012.10.078