title: Endovascular stent-graft in abdominal aortic aneurysms: the relationship between patent vessels that arise from the aneurysmal sac and early endoleak.
abstract: OBJECTIVE
  To determine the association of patent sac branch vessels (lumbar and inferior mesenteric arteries [IMAs]) with early endoleak rate after stent-graft repair of abdominal aortic aneurysm (AAA).
  
  
  METHODS
  Pre- and postoperative computed tomographic (CT) angiograms in 158 patients who underwent stent-graft AAA repair were retrospectively reviewed to determine the preoperative patency of IMAs and other sac branch vessels (feeders) and presence or absence of immediate postoperative endoleak. Relationships of early endoleak rate with total branch vessel, IMA, and lumbar artery patency and graft type were evaluated.
  
  
  RESULTS
  There was a significant association between patency of sac feeders and rate of early endoleak, especially type 2. As total patent feeders increased from zero to three to four to six, total endoleak rate increased from 6% (one of 17) to 35% (30 of 86); type 2 endoleak rate, from 0% to 25%. IMA patency was significantly associated with total early endoleak rate. Increasing lumbar artery patency also was associated with significantly higher total and type 2 endoleak rates: With zero to three lumbar arteries, the total endoleak rate was 17% and type 2 endoleak rate was 13%, as compared with 60% and 50%, respectively, with more than six patent lumbar arteries.
  
  
  CONCLUSIONS
  Sac branch vessel patency is associated with significantly higher early total and type 2 endoleak rates after stent-graft repair of AAAs; thus, patent sac branches play an important role in the pathogenesis of endoleaks.
authors.affiliation: Division of Vascular Radiology, Massachusetts General Hospital, 55 Fruit St, Gray 290, Boston, MA 02114, USA. cfan@partners.org
authors.forename: C M
authors.initials: CM
authors.lastname: Fan
authors.forename: E A
authors.initials: EA
authors.lastname: Rafferty
authors.forename: S C
authors.initials: SC
authors.lastname: Geller
authors.forename: J A
authors.initials: JA
authors.lastname: Kaufman
authors.forename: D C
authors.initials: DC
authors.lastname: Brewster
authors.forename: R P
authors.initials: RP
authors.lastname: Cambria
authors.forename: A C
authors.initials: AC
authors.lastname: Waltman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000637:transplantation*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency