title: Endothelial denudation combined with embolization in the prevention of endoleaks after endovascular aneurysm repair: an animal study.
abstract: OBJECTIVE
  To test whether combining embolization with endothelial denudation could reduce endoleak persistence and recurrence after endovascular aneurysm repair (EVAR) in an animal model.
  
  
  METHODS
  Type I endoleaks with collateral outflow were created in bilateral iliac aneurysms in 12 dogs. In 6 animals (group 1), endoleaks were treated by thrombin injection, with or without mechanical denudation of the endothelium. In the other 6 animals (group 2), simultaneous occlusion and endothelial denudation was induced in one side by treatment with a gel containing ethanol, ethylcellulose, and lipiodol, whereas the other side was treated with saline control. Follow-up ultrasonography and angiography were performed before necropsy and histology at 3 months.
  
  
  RESULTS
  Denudation combined with thrombin injection led to higher aneurysm shrinkage than thrombin alone, as shown by the mean relative aneurysm diameter (89% vs. 124% at baseline, p<0.01) and length (61% vs. 82% at baseline, p<0.01). Denudation did not significantly reduce endoleak occurrence (4/6 vs. 6/6); however, endoleaks in denuded aneurysms were significantly smaller and located in areas inaccessible to denudation. Six of the 10 endoleaks seen at 3 months occurred despite complete initial occlusion (recurrent endoleaks). In the gel-treated group, embolized aneurysms did not shrink significantly, and stent-graft thrombosis developed in 3/6 embolized aneurysms; however, the 3 other aneurysms showed no endoleaks, while all 6 saline-treated controls exhibited persistent endoleaks.
  
  
  CONCLUSIONS
  This study demonstrates the role of recanalization in endoleak recurrence and indicates that combining embolization and endothelial denudation could be a promising strategy to prevent endoleak persistence or recurrence after EVAR. However, the sclerosing gel tested in this study is not appropriate since it is prone to migration with resultant stent-graft thrombosis.
authors: Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada. sophie.lerouge@etsmtl.ca
authors: Sophie
authors: S
authors: Lerouge
authors: Marie-Christine
authors: MC
authors: Bonneviot
authors: Igor
authors: I
authors: Salazkin
authors: Jean
authors: J
authors: Raymond
authors: Gilles
authors: G
authors: Soulez
mesh_terms: D055011:Ablation Techniques; D000818:Animals; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003097:Collateral Circulation; D004195:Disease Models, Animal; D004285:Dogs; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D042783:Endothelial Cells / Q000473:pathology*; D057510:Endovascular Procedures / Q000009:adverse effects*; D017543:Iliac Aneurysm / Q000503:physiopathology / Q000601:surgery*; D007267:Injections; D011859:Radiography; D012008:Recurrence; D012039:Regional Blood Flow; D012597:Sclerosing Solutions / Q000008:administration & dosage; D013917:Thrombin / Q000008:administration & dosage; D013997:Time Factors; D018608:Ultrasonography, Doppler
chemical_list: D012597:Sclerosing Solutions; D013917:Thrombin