title: Preoperative Coil Embolization of Side Branches and Postoperative Antifibrinolytic Therapy in Endovascular Aneurysm Repair: A Propensity Score Analysis.
abstract: OBJECTIVE
  To demonstrate feasibility and efficacy of preoperative coil embolization of side branches and postoperative tranexamic acid (TXA) therapy for management of type II endoleak and aneurysmal sac regression after endovascular aortic repair (EVAR).
  
  
  METHODS
  This study included 284 patients who underwent EVAR between 2007 and 2014. In 133 patients (group A), since March 2012, preoperative coil embolization of side branches and postoperative TXA therapy had been introduced as a modified strategy after EVAR, including combined coil embolization and TXA therapy (n = 41), coil embolization only (n = 17), and TXA therapy only (n = 75). The remaining 151 patients (group B) underwent EVAR with no coil embolization and TXA therapy. After propensity score matching, postoperative results were retrospectively compared between 92 matched pairs (group A vs group B).
  
  
  RESULTS
  Matched comparison revealed no significant difference in incidence rate of type II endoleak at 6 months after EVAR between group A and group B (19.6% [18/92] vs 29.4% [27/92]; P = .1172). A significantly greater shrinkage of sac size at 6 months after EVAR (-8.5% ± 11.6 vs -3.6% ± 8.4; P = .0011) and significantly more rapid pace of sac shrinkage (change of size per year; -4.2 mm/y ± 7.6 vs -1.9 mm/y ± 6.1; P = .0301) were observed in group A.
  
  
  CONCLUSIONS
  Combined preoperative coil embolization of side branches and postoperative TXA therapy were associated with significantly more rapid aneurysmal sac regression after EVAR.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama 700-0804, Japan. Electronic address: bassbord1028@yahoo.co.jp.
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama 700-0804, Japan.
authors.forename: Genta
authors.initials: G
authors.lastname: Chikazawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama 700-0804, Japan.
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Ishida
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama 700-0804, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama 700-0804, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama 700-0804, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama 700-0804, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D000072226:Computed Tomography Angiography; D004334:Drug Administration Schedule; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D057216:Propensity Score; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D014148:Tranexamic Acid