Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair

Suvi Väärämäki; Herman Viitala; Sani Laukontaus; Ilkka Uurto; Patrick Björkman; Riikka Tulamo; Pekka Aho; Matti Laine; Velipekka Suominen; Maarit Venermo

doi:10.1016/j.ejvs.2022.11.009

Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair

Eur J Vasc Endovasc Surg. 2023 Feb;65(2):264-270. doi: 10.1016/j.ejvs.2022.11.009. Epub 2022 Nov 9.

Affiliations

¹ Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland. Electronic address: suvi.vaaramaki@pshp.fi.
² Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
³ Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland.

PMID: 36334900
DOI: 10.1016/j.ejvs.2022.11.009

Abstract

Objective: A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy in centre A) and leaving the IMA untouched (strategy in centre B).

Methods: Patients were treated with EVAR in two centres during the period 2005 - 2015, and the data were reviewed retrospectively. The primary endpoints were re-intervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR related re-intervention, sac enlargement, aneurysm rupture, and open conversion rates.

Results: Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed in 164 (41.5%). The corresponding figures for strategy B were 337 patients with 279 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean duration of follow up was 70 months for strategy A and 68.2 months for strategy B. The re-intervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .29), with no significant difference in the rate of re-interventions to occlude a patent IMA (2.0% and 4.7%, respectively; p = .039). The EVAR related re-intervention rate was similar, regardless of strategy (24.1% and 24.6%, respectively; p = .93). Significant sac enlargement was seen in 20.3% of cases treated with strategy A and in 19.6% treated with strategy B (p = .82). The rupture and conversion rates were 2.5% and 2.1% (p = .69) and 1.0% and 1.5% (p = .40), respectively.

Conclusion: The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should therefore be abandoned.

Keywords: AAA; EVAR; Embolisation; IMA; Prophylactic; Routine.

MeSH terms

Aortic Aneurysm, Abdominal* / complications
Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endoleak / epidemiology
Endoleak / etiology
Endoleak / therapy
Endovascular Aneurysm Repair
Endovascular Procedures* / adverse effects
Humans
Mesenteric Artery, Inferior / diagnostic imaging
Mesenteric Artery, Inferior / surgery
Retrospective Studies
Risk Factors
Treatment Outcome