Annals of vascular surgery · 2026
Prevention of Aneurysm Sac Enlargement after Endovascular Aneurysm Repair by Embolization of the Inferior Mesenteric and Lumbar Arteries.
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Seike Yoshimasa, Yoshida Kazufumi, Koda Yojiro, Shijo Takayuki, Inoue Yosuke, Horinouchi Hiroki, Fukuda Tetsuya, Matsuda Hitoshi
Аннотация
BACKGROUND: This study assessed whether preemptive side branch embolization improves early to mid-term outcomes after endovascular aneurysm repair (EVAR), focusing on sac enlargement and reintervention for persistent type II endoleak.
METHODS: A total of 536 patients were included and categorized into three periods based on embolization strategy. In period 1 (n = 142), no preemptive embolization was performed. In period 2 (n = 111), inferior mesenteric artery (IMA) embolization was conducted when indicated. In period 3 (n = 283), embolization of the IMA and/or lumbar arteries (LAs) was performed according to anatomical findings. Early and mid-term outcomes were evaluated across all three periods, with additional analysis performed using propensity score matching (PSM).
RESULTS: Freedom from sac enlargement (≥5 mm) was comparable between period 1 and period 2 groups (log-rank, P = 0.45) but was significantly higher in period 3 than in period 2 (log-rank, P < 0.01) and was significantly higher in period 3 compared to period 1 (log-rank, P < 0.01). Freedom from reintervention, including aneurysm rupture prior to reintervention, did not differ significantly among the three groups. After PSM, the period 3 group demonstrated significantly greater freedom from sac enlargement (log-rank, P < 0.01), whereas the rates of reintervention or rupture remained statistically similar across the groups.
CONCLUSION: An aggressive embolization strategy targeting both the IMA and LA was safe and associated with favorable early outcomes. Mid-term results suggested effective suppression of sac enlargement after EVAR. However, longer-term follow-up is required to confirm sustained benefits in reducing reintervention and rupture.
METHODS: A total of 536 patients were included and categorized into three periods based on embolization strategy. In period 1 (n = 142), no preemptive embolization was performed. In period 2 (n = 111), inferior mesenteric artery (IMA) embolization was conducted when indicated. In period 3 (n = 283), embolization of the IMA and/or lumbar arteries (LAs) was performed according to anatomical findings. Early and mid-term outcomes were evaluated across all three periods, with additional analysis performed using propensity score matching (PSM).
RESULTS: Freedom from sac enlargement (≥5 mm) was comparable between period 1 and period 2 groups (log-rank, P = 0.45) but was significantly higher in period 3 than in period 2 (log-rank, P < 0.01) and was significantly higher in period 3 compared to period 1 (log-rank, P < 0.01). Freedom from reintervention, including aneurysm rupture prior to reintervention, did not differ significantly among the three groups. After PSM, the period 3 group demonstrated significantly greater freedom from sac enlargement (log-rank, P < 0.01), whereas the rates of reintervention or rupture remained statistically similar across the groups.
CONCLUSION: An aggressive embolization strategy targeting both the IMA and LA was safe and associated with favorable early outcomes. Mid-term results suggested effective suppression of sac enlargement after EVAR. However, longer-term follow-up is required to confirm sustained benefits in reducing reintervention and rupture.