A study on the patency of the inferior mesenteric and lumbar arteries in the incidence of endoleak following endovascular repair of infra-renal aortic aneurysms.
OBJECTIVE
An endoleak is defined as the presence of contrast medium within the aneurysm sac on post-operative contrast-enhanced computed tomography scans (CT) in patients following endovascular repair (EVR) of abdominal aortic aneurysms (AAA). The aim of this study was to correlate the incidence of endoleaks with the presence of patent lumbar (LA) and inferior mesenteric arteries (IMA) as seen on pre-operative angiography.


METHODS
Forty-seven patients were assessed pre-operatively by both CT and angiography by a blinded radiologist prior to EVR of AAA. The number and size of patent vessels was recorded and correlated with the incidence of LA or IMA endoleaks on follow-up CT. Patent lumbar vessels were scored: 1 = small, 2 = medium, 3 = large.


RESULTS
Five patients were noted to have patent IMA on pre-operative angiography but none developed an endoleak. In this series, five patients had an endoleak due to a patent LA. The median score for patients with no endoleak was 1 (0-9) and for those with a lumbar endoleak 2 (0-5) (P = 0.26, Mann-Whitney U-test). The number of patent lumbar arteries was not predictive of a subsequent endoleak. Two out of nine (22 %) patients with large patent LA subsequently developed an endoleak. If a policy of pre-operative embolization on the basis of large patent LA had been adopted, seven patients would have had an unnecessary invasive procedure.


CONCLUSIONS
Pre-operative angiography to look for patent LA and IMAs is not required in patients undergoing EVR or AAA.
Walker
S R
SR
Department of Vascular and Endovascular Surgery, Queens Medical Centre, Nottingham, UK.
Halliday
K
K
Yusuf
S W
SW
Davidson
I
I
Whitaker
S C
SC
Gregson
R H
RH
Hopkinson
B R
BR
D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001158:Arteries / Q000503:physiopathology; D003287:Contrast Media; D005500:Follow-Up Studies; D006801:Humans; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011183:Postoperative Complications; D012307:Risk Factors; D016037:Single-Blind Method; D013116:Spinal Cord / Q000098:blood supply; D015607:Stents; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency
D003287:Contrast Media