Type 2 Endoleaks after Abdominal Aortic Aneurysm Stent Grafting with Systematic Mesenteric and Lumbar Coil Embolization
| Autor: | Michael H. Wholey, Rajeev Suri, Boulos Toursarkissian, Maureen K. Sheehan, Darren Postoak, Edith D. Canby, Ryan T. Hagino |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Inferior mesenteric artery Blood Vessel Prosthesis Implantation Lumbar Aneurysm medicine.artery Secondary Prevention medicine Humans Embolization Aged Retrospective Studies Coil embolization business.industry Lumbosacral Region Mesenteric Artery Inferior Arteries General Medicine Middle Aged medicine.disease Combined Modality Therapy Embolization Therapeutic Abdominal aortic aneurysm Surgery Female Stents Cardiology and Cardiovascular Medicine business Angioplasty Balloon Lumbar arteries Aortic Aneurysm Abdominal Follow-Up Studies Abdominal surgery |
| Zdroj: | Annals of Vascular Surgery. 20:458-463 |
| ISSN: | 0890-5096 |
| DOI: | 10.1007/s10016-006-9103-2 |
| Popis: | We evaluated the results of our policy of systematic coil embolization of the inferior mesenteric artery (IMA) and/or lumbar arteries (LAs) prior to endovascular abdominal aortic aneurysm (AAA) repair (EVAR). We retrospectively reviewed all patients undergoing EVAR over a 4-year period at one hospital. Results were analyzed using uni- and multivariate analyses. Fifty-five male patients with an average age of 71 years were evaluated. Follow-up averaged 15 +/- 13 months. The IMA was either coiled or occluded in 30 cases. One or more LAs were coiled in 29 patients. An average of 1.3 LAs per patients were coiled (range 0-6). There were no immediate or late complications from coiling. At last follow-up, 14 AAAs showed no change in diameter, one increased by 2 mm, and the remainder (n = 40) decreased by 7.5 +/- 6 mm in maximal diameter. Only five (9%) type 2 endoleaks were detected during follow-up. Three were associated with AAA size increase. Four of the five were treated with additional coiling, with good results. By logistic regression, neither endoleak occurrence nor AAA shrinkage correlated with LA or IMA coiling. However, by multivariate analysis, completeness of lumbar coiling correlated negatively with aneurysm shrinkage (p = 0.04) and IMA coiling correlated positively with aneurysm shrinkage (p = 0.04). Coil embolization of the IMA and/or LAs prior to EVAR can be safely accomplished in a large number of cases and is associated with a low incidence of type 2 endoleaks. We cannot at present demonstrate a benefit to LA embolization in terms of endoleak prevention or AAA shrinkage. However, IMA embolization may be of benefit in terms of AAA shrinkage. |
| Databáze: | OpenAIRE |
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