title: Operative Treatment of Type 2 Endoleaks Involving the Inferior Mesenteric Artery.
abstract: BACKGROUND
  We report the results of the operative treatment for type 2 endoleak (T2E) involving the inferior mesenteric artery (IMA) using the transarterial embolization (TAE) or the video laparoscopic ligation (VLS).
  
  
  METHODS
  Between January 2005 and December 2015, we retrospectively analyzed 901 patients treated with endovascular aortic repair (EVAR): 883 (98%) had 1 valid postoperative radiologic evaluation, at least. All patients with operative repair for IMA-related T2E entered the final analysis. Indication of their operative repair was sac enlargement (>5 mm within 6 months or >1 cm from the preoperative diameter, irrespectively of the postoperational time) and/or its persistence >12 months.
  
  
  RESULTS
  We detected 192 (21.7%) T2Es, overall. We identified 37 (4.2%) IMA-related T2Es, and treated 21 cases (VLS n = 11, TAE n = 10). Aneurysm-related mortality and major or minor morbidity was never observed. Time of intervention did not differ significantly (minutes, VLS = 97 ± 46 vs. TAE = 95 ± 21, P = 0.901). Hospitalization was significantly lower in the TAE group (days, 4 ± 2 vs. 1 ± 0.4, P < 0.001). No patient was lost at a mean follow-up of 46 ± 32 months (range, 1-110; median, 48). At last follow-up, sac diameter was significantly more stable in the VLS (mm, 60 ± 10 vs. 55 ± 7, P = 0.593) than that in the TAE group (mm, 57 ± 9 vs. 63 ± 10, P = 0.050). The IMA-related T2E reintervention rate was not significantly different between the groups (VLS, n = 0 [0%] vs. TAE, n = 2 [20.0%], P = 0.213). Secondary aortic reintervention rate was 28.6% (n = 6), and secondary open conversion rate was 9.5% (VLS, n = 1 [9.1%] vs. TAE, n = 1 [10.0%], P = 1).
  
  
  CONCLUSIONS
  In authors' experience, operative treatment of IMA-related T2E was safe; VLS proved to be effective and durable in sealing this type of T2E. Patients receiving correction of IMA-related T2E after EVAR remained at risk for development of any type of endoleaks, as well as at risk of reintervention.
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Piffaretti
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Franchin
authors.affiliation: Vascular Surgery, Department of Surgery, Spedali Civili Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Botteri
authors.affiliation: General Surgery 1, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.affiliation: Interventional Radiology, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
authors.affiliation: Radiology 2, Department of Surgery, Spedali Civili Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Battaglia
authors.affiliation: Vascular Surgery, Department of Surgery, Spedali Civili Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonardelli
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Castelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016208:Databases, Factual; D004621:Embolization, Therapeutic / Q000009:adverse effects; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008026:Ligation; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000379:methods*