Preoperative embolization of collateral side branches: a valid means to reduce type II endoleaks after endovascular AAA repair.
OBJECTIVE
To report the results of preprocedural embolization of collateral branches arising from abdominal aortic aneurysms (AAA) scheduled for endovascular repair.


METHODS
Twenty-three consecutive AAA patients (all men; mean age 73 years, range 56-82) had coil embolization of patent lumbar and inferior mesenteric arteries (IMA) in a staged procedure prior to endovascular repair. Embolization with microcoils was attempted in 37 of the 52 identified lumbar arteries and 14 of 15 inferior mesenteric arteries. Follow-up included biplanar abdominal radiography, spiral computed tomography, and duplex ultrasonography at 1, 30, 90, and 180 days after the stent-graft procedure and at 6-month intervals thereafter.


RESULTS
Successful embolization was obtained in 24 (65%) of lumbar arteries, while all 14 (100%) IMAs were occluded with coils. No complication was associated with embolotherapy. Over a mean 17-month follow-up of 22 patients (1 intraoperative death), there was only 1 (4.5%) type II endoleak from a patent lumbar artery, with no sac expansion after 2 years. There were 4 (18%) type I and 1 (4.5%) type III endoleaks.


CONCLUSIONS
The embolization of side branches arising from an infrarenal aortic aneurysm before endovascular repair is feasible, with a high success rate; this maneuver may play a relevant role in reducing the rate of type II endoleak, improving long-term outcome.
Bonvini
Robert
R
Department of Vascular Medicine, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland.
Alerci
Mario
M
Antonucci
Francesco
F
Tutta
Paolo
P
Wyttenbach
Rolf
R
Bogen
Marcel
M
Pelloni
Angelo
A
Von Segesser
Ludwig
L
Gallino
Augusto
A
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008161:Lumbosacral Region / Q000098:blood supply / Q000601:surgery; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D016896:Treatment Outcome