Intraoperative sac coiling embolization in type Ⅱ endoleak high-risk population after endovascular aortic repair / 中华普通外科杂志

ABSTRACT

Objective To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair (EVAR).Methods From Jan 2014 to Jan 2018,one hundred and twelve consecutive patients with infrarenal AAA were enrolled for this study,There were 76 patients undergoing standard EVAR (standard-group) and 36 patients doing aneurysmal sac coiling embolization (embo-group).Baseline characteristics,aneurysmal sac parameters,radiological intervention details and follow up results were recorded.Results Mean follow-up time was 25.9 m for embo-group.During follow-up period,no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported.A mean of (2.72 ± 1.16) coils (range 1-7) was used in the embo-group.The incidence of type Ⅱ endoleak was 30.3％ (23/76) in standard-group and 11.1％ (4/36) in embo-group(x2 =4.90,P =0.027).Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume ≥ 128 cm3.In the subgroup analysis (sac volume≥ 128 cm3),the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group (x2 =6.07,P =0.014).Conclusion Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak.This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.