Impact of intrasac thrombus and a patent inferior mesenteric artery on EVAR outcome.
OBJECTIVE
To assess the significance of a patent inferior mesenteric artery (IMA) and presence of intrasac thrombus on the outcome of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA).


METHODS
Between June 2004 and June 2007, 114 AAA patients (100 men; mean age 75 years, range 56-87) treated electively with a bifurcated stent-graft were assessed with computed tomography pre- and postoperatively. Incidences of type II endoleaks and reinterventions were compared with preoperative intrasac thrombus and IMA patency.


RESULTS
Over a mean follow-up of 19 months (range 6-38), there was no aneurysm rupture. Eleven (11%) of 101 patients with and 7 (54%) of 13 patients without preoperative intrasac thrombus presented with a type II endoleak (p<0.01). The postoperative change in aneurysm diameter was 0 mm (-20 to 16) in 18 patients with type II endoleak and -9 mm (-30 to 18) in sealed aneurysms (p<0.001). Fourteen (78%) type II endoleaks originated from lumbar arteries and 4 (22%) from the IMA in spite of the fact that most patients (69%) had a patent IMA. There were 5 reinterventions for type II endoleak with expansion of the sac. The reinterventions did not seem related to intrasac thrombus or a patent IMA. Prophylactic embolization of the IMA was unsuccessful in 4 (33%) cases.


CONCLUSIONS
In this series, type II endoleaks inhibited sac shrinkage and occurred more frequently in aneurysms without intrasac thrombus. Most type II endoleaks originated from lumbar arteries and not from the IMA. Prophylactic embolization of the IMA does not seem justified and is not always technically successful.
Fujita
Satoko
S
Vascular Center Malmö-Lund, Malmö University Hospital, Malmö, Sweden. s-fujita.srg1@tmd.ac.jp
Resch
Timothy A
TA
Kristmundsson
Thorarinn
T
Sonesson
Björn
B
Lindblad
Bengt
B
Malina
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D019992:Databases as Topic; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D013548:Sweden; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014654:Vascular Patency