Cuff-first technique is associated with a lower 6-month type II endoleak rate after endovascular aneurysm repair for infrarenal abdominal aortic aneurysm.

OBJECTIVE

Type II endoleak (T2EL) remains the most common endoleak after endovascular aneurysm repair. We evaluated whether the cuff-first technique (CFT), in which an aortic cuff is deployed at the branch-vessel level before main-body deployment, is associated with lower early T2EL rates.

METHODS

We performed a single-center retrospective comparative study of infrarenal endovascular aneurysm repair (October 2020-December 2024). Patients without contrast-enhanced computed tomography at 6 months and other predefined exclusions were excluded. The primary endpoint was T2EL on 6-month computed tomography (early and delayed phases). Secondary endpoints included aneurysm sac regression ≥5 mm at 6 months, reintervention for T2EL, operative time, contrast volume, and radiation exposure (air kerma). Freedom from reintervention was analyzed by Kaplan-Meier methods.

RESULTS

We analyzed 100 patients (cuff-first, n = 33; noncuff-first, n = 67). Inferior mesenteric artery patency (93.9% vs 74.6%; P = .028) and diameter (2.4 ± 1.0 vs 1.8 ± 1.3 mm; P = .039) were higher in the cuff-first group, whereas lumbar artery counts were similar (5.5 ± 1.8 vs 5.4 ± 1.8; P = .827). At 6 months, T2EL was less frequent with the CFT (9.1% vs 31.3%; P = .014), and aneurysm sac regression ≥5 mm was more frequent (24.2% vs 7.5%; P = .027). Operative time, contrast volume, and radiation exposure did not differ significantly. Reintervention for T2EL occurred in one cuff-first patient and seven noncuff-first patients; freedom from reintervention at 36 months was 94.7% vs 85.5% (log-rank P = .251).

CONCLUSIONS

The CFT was associated with lower 6-month T2EL rates and higher early sac regression without increasing procedural burden. Larger studies with longer follow-up are warranted.