title: Is Inferior Mesenteric Artery Embolization Indicated Prior to Endovascular Repair of Abdominal Aortic Aneurysm?
abstract: Type II endoleak is a common condition occurring after endovascular repair of abdominal aortic aneurysms (EVAR), and may result in aneurysm sac growth and/or rupture in a small number of patients. A prophylactic strategy of inferior mesenteric artery (IMA) embolization before EVAR has been advocated, however, the benefits of this strategy are controversial. A clinical vignette allows the authors to summarize the available data about this issue and discuss the possible benefits and risks of prophylactic IMA embolization before EVAR. The authors performed a meta-analysis of available data which showed that the pooled rate of type II endoleak after IMA embolization was 19.9% (95% CI 3.4-34.7%, I2 93%) whereas it was 41.4% (95% CI 30.4-52.3%, I2 76%) in patients without IMA embolization (5 studies including 596 patients: p < .0001, OR 0.369, 95% CI 0.22-0.61, I2 27%). Since treatment for type II endoleaks is needed in less than 20% of cases and this complication can be treated successfully in 60-70% of cases resulting in an aneurysm rupture risk of 0.9%, these data indicate that embolization of patent IMA may be of no benefit in patients undergoing EVAR.
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
authors: F
authors: F
authors: Biancari
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: J
authors: J
authors: Mäkelä
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: T
authors: T
authors: Juvonen
authors: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
authors: M
authors: M
authors: Venermo
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000517:prevention & control; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*
keywords: Abdominal aortic aneurysm; EVAR; Embolization; Endoleak; Endovascular; Inferior mesenteric artery