04:12 PM Abstract No. 31 Predictive value of pre-procedural computed tomography angiogram on technical success of transarterial embolization of type II endoleaks arising from lumbar arteries

Abstract

To evaluate the ability of pre-procedural CTA to predict the technical success of embolization of post-EVAR type II endoleaks arising from lumbar arteries. All patients at a single academic institution with post-EVAR type II endoleak from 2008-2018 were retrospectively reviewed. Patients without CTA were excluded. CTAs were reviewed for the ability to trace the entire course of vessels feeding the endoleak. Successful tracing was defined as identification of a feeding vessel from the internal iliac artery to the lumbar artery at the site of endoleak. Procedural imaging was reviewed for technical success, defined as catheterization of the lumbar artery at the site of endoleak. Sixty-eight patients with a type II endoleak underwent 75 transarterial interventions during the study period. Of these interventions, CTA prior to 57 angiograms (76%) showed a type II endoleak with a suspected feeding lumbar artery based on endoleak location along the posterior wall of the aorta. The supplying artery could be traced on prior CTA in 18 (32%) procedures, and embolization was technically successful in 16/18 (89%). In the remaining 39 (68%) procedures where the supplying artery could not be traced on prior CTA, the technical success rate was 10/39 (26%). The 31 endoleaks that were not treated via the iliolumbar artery branches were managed with embolization of the IMA origin through the Arc of Riolan (n=5), percutaneous aneurysm sac puncture (n=17), transcaval sac puncture (n=2), additional endograft placement (n=1), or active surveillance (n=6). A potential catheter path from the internal iliac artery through the iliolumbar and lumbar arteries to the aneurysm sac can be traced on CTA in the minority of lumbar-supplied type II endoleaks. The ability to trace these inflow vessels on preprocedural CTA is a reliable predictor of technical success during embolization. Low rates of technical success were identified when the feeding vessel could not be traced on CTA, suggesting these patients should be considered for a different approach such as percutaneous or transcaval aneurysm sac puncture.