Pre-emptive embolization of aneurysm sac side branches prevents post-EVAR type II endoleak, study finds

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Daniela Branzan

According to Daniela Branzan, MD, a senior vascular surgeon at University Hospital Leipzig, in Leipzig, Germany, and colleagues, pre-emptive embolization of aneurysm sac side branches for patients with abdominal aortic aneurysm (AAA) is “safe and effective” in preventing type II endoleak after endovascular aneurysm repair (EVAR) and results in aneurysm sac shrinkage.

Writing in the Journal of Vascular Surgery (JVS), Branzan et al write that type II endoleak is the most common endoleak after EVAR, yet its optimal management is hotly debated.

They note that preliminary selective embolization of aneurysm sac side branches has been adopted to prevent type II endoleak, and so the investigators’ goal with this study was to determine the rate of type II endoleak and diameter decrease of AAA after EVAR following pre-emptive embolization of aneurysm sac side branches.

The authors detail that, between September 2014 and September 2019, 139 patients with AAA underwent percutaneous aneurysm sac side branch embolization before EVAR. Imaging follow-up was performed at one and six months, then yearly.

Endpoints included freedom from type II endoleak, AAA sac shrinkage, type II endoleak-related reinterventions, and all-cause mortality. Branzan and colleagues specify that mean follow-up was 23Å}16 months and that patients had a median of five patent aneurysm sac side branches.

After completion of embolization, the authors report in JVS that 76.4% of initially patent aneurysm sac side branches were occluded, with no major procedure-related complications.

They note that follow-up imaging showed type II endoleak in seven (5%) patients and that an increase of the aneurysm sac was seen in six. They also report six type II endoleak-related reinterventions during follow-up.

Branzen et al add that the majority of patients (86.7%) exhibited aneurysm sac shrinkage and a mean diameter reduction was 9.2mm (p<0.001). They also report one aneurysm-related death within 30 days after EVAR.

SOURCE: DOI.ORG/10.1016/J.JVS.2020.11.032

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