Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms.
OBJECTIVE
To review the incidence and repair of inferior mesenteric arterial (IMA) type II endoleaks after endovascular repair of abdominal aortic aneurysms.


METHODS
Fifty patients who underwent endovascular repair of abdominal aortic aneurysms were examined. If an endoleak was identified at 30-day postoperative computed tomography, conventional arteriography was performed to identify and eliminate its source. After the exclusion of attachment site leaks, a catheter was placed selectively in the superior mesenteric artery (SMA). If retrograde filling of the IMA and aneurysm was identified, coil embolization was attempted through the SMA and middle colic artery. Intrasac pressures were measured at embolization.


RESULTS
Eight of 50 patients (16%) had type II endoleaks that were attributed to retrograde flow in the IMA. Intrasac measurements demonstrated systemic pressure in six patients and one-half systemic pressure in two patients. The IMA was embolized through the SMA and left colic artery in seven patients and through the translumbar aorta in one patient.


CONCLUSIONS
Retrograde flow in the IMA is responsible for many type II endoleaks. Systemic pressures are transmitted into the aneurysm sac from the IMA. The IMA can be embolized successfully with an SMA approach in most patients.
Baum
R A
RA
Section of Interventional Radiology, Department of Radiology, University of Pennsylvania, PA 19104, USA. baumr@rad.upenn.edu
Carpenter
J P
JP
Tuite
C M
CM
Velazquez
O C
OC
Soulen
M C
MC
Barker
C F
CF
Golden
M A
MA
Pyeron
A M
AM
Fairman
R M
RM
D000714:Anastomosis, Surgical / Q000009:adverse effects*; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002406:Catheterization, Peripheral; D003097:Collateral Circulation / Q000502:physiology; D003106:Colon / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D017537:Mesenteric Artery, Inferior / Q000503:physiopathology*; D017538:Mesenteric Artery, Superior / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed