Endovascular Aortic Aneurysm Repair without Type 2 Endoleak Using Concomitant N-Butyl-2-Cyanoacrylate Injection into the Abdominal Aortic Aneurysm Sac

Abstract

The aim of this study was to evaluate our new method to occlude target lumber arteries using N-butyl-2-cyanoacrylate (NBCA) during endovascular aneurysm repair (EVAR) for prevention of type 2 endoleak (T2E). Between 2013 and 2018, 176 patients who underwent EVAR for abdominal aortic aneurysm (AAA) were reviewed. Starting from October 2015, 83 patients (treatment group) underwent NBCA injection into the aneurysmal sac during EVAR. The incidence of T2E at 7days and AAA sac diameter 12months after EVAR were compared with those of the control group comprising 93 consecutive patients who underwent EVAR alone before 2015. The incidence of T2E at 7days was significantly lower in the treatment group (2.4%) than in the control group (22.6%) (P<0.001). AAA sac diameter at 12months in the treatment group had a mean decrease of 6.6mm as compared with the mean 4.4mm in the control group (P=0.026). In multivariate analysis, NBCA injection was significantly related to the reduction of incidence of T2E at 7days (odds ratio=11.8, P<0.001) and a decrease in AAA sac diameter at 12months (P<0.001). There was no NBCA injection-related complication and reintervention in the treatment group. NBCA injection might be safe and useful to reduce the incidence of T2Es and to prevent AAA sac expansion.