SS12 - Clinical Significance of Lumbar Artery Embolization in Addition to Inferior Mesenteric Artery Embolization to Reduce Persistent Type 2 Endoleak at Endovascular Aneurysm Repair
Objectives: Persistent type 2 endoleak (T2EL) after endovascular aneurysm repair (EVAR) lead to higher likelihood of re-intervention, sac enlargement and other adverse outcomes. While embolization of the inferior mesenteric artery (IMA-E) can decrease T2EL, additional effects of lumbar artery embolization (LA-E) remain undetermined. The aim was to evaluate the effects of preemptive LA-E at EVAR on the incidences of persistent T2EL and related complications. Safety and radiation exposure were also analyzed.
Methods: Consecutive patients who underwent EVAR for abdominal aortic aneurysm between 2013 and 2021 were included. Preemptive embolization were IMA-E before April 2018, and IMA-E plus LA-E thereafter. Patients with occluded IMA/LA, severe renal dysfunction, short life expectancy or contraindication to contrast agents were not considered for preemptive embolization (NO-E). The incidence of T2EL, sac enlargement (>5mm), re-intervention and other adverse events were compared between 3 different strategies, as well as radiation time and dose area products (DAP).
Results: There were 243, 216 and 158 patients in the NO-E, IMA-E and LA-E groups, respectively. Statistical differences in the backgrounds were found in age, sex, respiratory impairment, chronic kidney disease, hostile abdomen, aneurysm diameter, proximal neck length, right distal landing length and device used. T2EL occurred at 20.7%, 24.0% and 9.7% in the NO-E, IMA-E and LA-E groups at 1 year, 27.7%, 30.8% and 12.1% at 2 years and 29.3%, 30.7% and 9.8% at 3 years. After adjustment for confounding factors, LA-E compared to IMA-E was less likely to develop T2EL at 1 year (odds ratio [OR], 0.31 95% confidence intervals [0.14–0.66]), 2 years (OR, 0.28 [0.13–0.61]) and 3 years (OR, 0.23 [0.08–0.66]). Similarly, LA-E compared to NO-E was associated with less T2EL at 1 year (OR, 0.45 [0.21–0.96]), 2 years (OR, 0.36 [0.17–0.78]) and 3 years (OR, 0.29 [0.10–0.87]). Re-intervention until 3 years was less frequent after LA-E compared to IMA-E (OR, 0.18 [0.05–0.63]) and NO-E (OR, 0.15 [0.04–0.50]). Sac shrinkage was larger after LA-E compared to IMA-E (differences, 2.9±1.4 mm) and NO-E (differences, 2.9±1.4 mm). Surgical conversion, sac enlargement, rupture and aneurysm-related death were not statistically different. No embolization-related complication was reported. Radiation time (min) and DAP (Gycm2) for NO-E, IMA-E and LA-E were 61±47, 58±39, 76±43 (p=.0002), and 432±330, 471±345, 640±454 (p <.0001), respectively.
Conclusions: LA-E in addition to IMA-E can decrease persistent T2EL and re-intervention over 3 years. While excessive radiation exposure limits routine use of LA-E and warrants future innovation on imaging guidance, longer-term effects of LA-E are encouraging.