Ces radiol. 2017, 71(2):137-145 | DOI: 10.55095/CesRadiol2017/018

Preoperative embolisation of lumbar and inferior mesenteric arteries before endovascular abdominal aortic aneurysm repair: Does preoperative embolisation decrease incidence of collateral endoleak and radiation dose?Original article

Miroslav Lojík¹, Jan Raupach¹, Vendelín Chovanec¹, Ondřej Renc¹, Pavla Čabelková¹, Igor Guňka², Michal Leško², Antonín Krajina¹

¹ Radiologická klinika Fakultní nemocnice, Hradec Králové

² Chirurgická klinika Fakultní nemocnice, Hradec Králové

Aim: To evaluate effect of endovascular abdominal aortic aneurysm repair in patients, whom preoperative embolisation of the aortic branches was done in prevention of collateral endoleak. To determine whether preoperative embolisation of the side branches decreases the incidence of collateral endoleaks, reduces follow-up CT examinations. The second goal was to compare radiation doses in embolised versus non-embolised patients.

Methods: From January 2010 to April 2015 we retrospectively evaluated 45 patients with the abdominal aortic aneurysm (38 men and 7 women, mean age 80 years) who were divided into three groups, each of 15 patients. The first group consisted of patients in whom were preoperatively diagnosed and then embolized side branches arising from the aneurysmal sac. The second group consisted of patients from the same period whom the CTA did not prove suitable arteries for preventive embolisation. Third group consisted of patients in whom during retrospective evaluation were identified patent arteries, which had not been preventively embolised.

Results: From a total of 45 evaluated patients, type II endoleak developed in 12 patients (27%). In the first group endoleak occured once (6%), in the second group 3 times (20%) and in the third group 8 times (53%). In the follow-up period CT study was carried out in the first group, in 1.46 CT examination/patient in average, in the second group 1.33 and in the third group 3.0 CT examinations/patient. Endovascular intervention for collateral endoleak and enlarging AAA sac was performed in 1 patient in the first group and in 4 patients in the third group. In the second group endovascular reintervention was not necessary.

Conclusion: Our results confirm that preventive preoperative embolisation of the arterial side branches arising from the the sac of the abdominal aortic aneurysm reduces the incidence of collateral endoleaks and has tendency to decreases number of postoperative CT examinations and reduces overall radiation exposure. Further evaluation of this approach is neccessary in a larger number of patients.

Keywords: aortic abdominal aneurysm, collateral endoleak, preoperative embolisation of lumbar and mesenteric artery

Accepted: March 30, 2017; Published: June 1, 2017  Show citation