Key result
Preoperative coil embolization before EVAR linked to doubled aneurysm sac shrinkage at 6 months.
Why the study?
Persistent Type 2 endoleaks after EVAR for abdominal aortic aneurysm are associated with adverse outcomes including sac enlargement and rupture, motivating evaluation of preoperative coil embolization to prevent sac growth.
Does preoperative coil embolization to aortic branched vessels improve aneurysmal sac shrinkage in patients undergoing EVAR for abdominal aortic aneurysm?
Cohort (n=215)
No
Does preoperative coil embolization to aortic branched vessels improve aneurysmal sac shrinkage in patients undergoing EVAR for abdominal aortic aneurysm?
Absolute Event Rate: 50% vs 25%
Preoperative coil embolization of aortic branch vessels before EVAR may promote aneurysmal sac shrinkage at 6 months, potentially reducing late complications from Type 2 endoleaks.
May support embolization in select EVAR cases; hypothesis-generating and requires RCTs before practice change.
OBJECTIVE: Persistent Type 2 endoleaks (PT2) after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) are associated with increased adverse outcomes, including aneurysmal sac enlargement and rupture. The aim of this study was to report early clinical outcomes of coil embolization (CE) to aortic branched vessels prior to EVAR and assess the effectiveness of this strategy in terms of prevention of sac growth due to PT2. MATERIALS AND METHODS: Between May 2007 and April 2012, EVAR was performed for 215 cases, divided into two groups (150 cases in Group A, before introduction of CE; 21 in Group B, receiving CE before EVAR). Early clinical outcomes were compared between groups. RESULTS: Fifty percent of cases in Group B had a marked reduction of aneurysmal sac diameter based on multi-detector row computed tomographic angiography (MDCTA) findings at the 6-month follow-up after EVAR, whereas, only 25% of cases in Group A had shrinkage of the aneurysmal sac during the same time period after EVAR. CONCLUSION: This strategy has the possibility of improving late outcomes of EVAR by reducing endoleak volumes beforehand.
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Chikazawa et al. (2013) conducted a cohort in Abdominal aortic aneurysm (AAA) (n=215). Preoperative coil embolization to aortic branched vessels vs. EVAR without preoperative coil embolization was evaluated on Marked reduction of aneurysmal sac diameter at 6-month follow-up. Preoperative coil embolization to aortic branched vessels prior to EVAR resulted in aneurysmal sac shrinkage in 50% of patients at 6 months, compared to 25% in those without preoperative embolization.
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