Side branch embolization before endovascular abdominal aortic aneurysm repair to prevent type II endoleak: A prospective multicenter study

Tomoyuki Gentsu; Masato Yamaguchi; Koji Sasaki; Ryota Kawasaki; Hiroki Horinouchi; Tetsuya Fukuda; Naokazu Miyamoto; Takeki Mori; Noriaki Sakamoto; Kensuke Uotani; Takanori Taniguchi; Yojiro Koda; Katsuhiro Yamanaka; Hiroaki Takahashi; Kenji Okada; Taro Hayashi; Toshitaka Watanabe; Yoshikatsu Nomura; Keigo Matsushiro; Eisuke Ueshima; Takuya Okada; Koji Sugimoto; Takamichi Murakami

doi:10.1016/j.diii.2024.03.003

Side branch embolization before endovascular abdominal aortic aneurysm repair to prevent type II endoleak: A prospective multicenter study

Diagn Interv Imaging. 2024 Mar 18:S2211-5684(24)00079-2. doi: 10.1016/j.diii.2024.03.003. Online ahead of print.

Authors

Tomoyuki Gentsu¹, Masato Yamaguchi², Koji Sasaki¹, Ryota Kawasaki³, Hiroki Horinouchi⁴, Tetsuya Fukuda⁴, Naokazu Miyamoto⁵, Takeki Mori⁶, Noriaki Sakamoto⁷, Kensuke Uotani⁸, Takanori Taniguchi⁹, Yojiro Koda¹⁰, Katsuhiro Yamanaka¹⁰, Hiroaki Takahashi¹⁰, Kenji Okada¹⁰, Taro Hayashi¹¹, Toshitaka Watanabe¹¹, Yoshikatsu Nomura¹², Keigo Matsushiro¹, Eisuke Ueshima¹, Takuya Okada¹, Koji Sugimoto¹, Takamichi Murakami¹

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Kobe University Hospital, Kobe, 7-5-2 Kusunokicho, Chuo Ward, Kobe City, Hyogo 650-0017, Japan.
² Department of Diagnostic and Interventional Radiology, Kobe University Hospital, Kobe, 7-5-2 Kusunokicho, Chuo Ward, Kobe City, Hyogo 650-0017, Japan. Electronic address: masato03310402@yahoo.co.jp.
³ Department of Diagnostic and Interventional Radiology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo 670-8560, Japan.
⁴ Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan.
⁵ Department of Radiology, Kita-harima Medical Center, Ono, Hyogo 675-1323, Japan.
⁶ Department of Radiology, Japanese Red Cross Kobe Hospital, Kobe, Hyogo 651-0073, Japan.
⁷ Department of Diagnostic and Interventional Radiology, Kakogawa Central City Hospital, Kakogawa, Hyogo 675-8520, Japan.
⁸ Department of Radiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo 656-0021, Japan.
⁹ Department of Radiology, Tenri Hospital, Tenri, Nara 632-8552, Japan.
¹⁰ Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
¹¹ Department of Cardiovascular Surgery, Akashi Medical Center, Akashi, Hyogo 673-0896, Japan.
¹² Department of Cardiovascular Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo 670-8560, Japan.

PMID: 38503637
DOI: 10.1016/j.diii.2024.03.003

Abstract

Purpose: The purpose of the study was to evaluate the efficacy and safety of pre-emptive transcatheter arterial embolization (P-TAE) of aortic side branches to prevent type II endoleak in patients with abdominal aortic aneurysm after endovascular abdominal aneurysm repair (EVAR).

Materials and methods: This multicenter, prospective, single-arm trial enrolled 100 patients with abdominal aortic aneurysm from nine hospitals between 2018 and 2021. There were 85 men and 15 women, with a mean age of 79.6 ± 6.0 (standard deviation) years (range: 65-97 years). P-TAE was attempted for patent aortic side branches, including the inferior mesenteric artery, lumbar arteries, and other branches. The primary endpoint was late type II endoleak incidence at 6 months post-repair. Secondary endpoints included changes in aneurysmal sac diameter at 6- and 12 months, complications, re-intervention, and aneurysm-related mortality. Aneurysm sac changes at 6- and 12 months was compared between the late and no-late type II endoleak groups.

Results: Coil embolization was successful in 80.9% (321/397) of patent aortic side branches, including 86.3% of the inferior mesenteric arteries, 80.3% of lumbar arteries, and 55.6% of other branches without severe adverse events. Late type II endoleak incidence at 6 months was 8.9% (8/90; 95% confidence interval: 3.9-16.8%). Aneurysm sac shrinkage > 5 mm was observed in 41.1% (37/90) and 55.3% (47/85) of the patients at 6- and 12-months post-EVAR, respectively. Patients with late type II endoleak had less aneurysm sac shrinkage than those without type II endoleak at 12 months (-0.2 mm vs. -6.0 mm; P = 0.040). No patients required re-intervention for type II endoleak, and no aneurysm-related mortalities occurred.

Conclusion: P-TAE is safe and effective in preventing type II endoleak, leading to early sac shrinkage at 12 months following EVAR.

Keywords: Abdominal aortic aneurysm, embolization; Endoleak; Endovascular aneurysm repair; Interventional radiology; Safety.