Identification of Anatomical Risk Factors for Type II Endoleak to Guide Selective Inferior Mesenteric Artery Embolization

Abstract

It is unclear which patients are the best candidates for inferior mesenteric artery (IMA) embolization to reduce type II endoleak (ELII). Therefore, this study aimed to identify the anatomical risk factors for ELII after endovascular aneurysm repair (EVAR) and to determine the best candidates for preventative, preoperative IMA embolization. Between April 2007 and September 2014, 196 patients underwent standard EVAR. Anatomical risk factors of postoperative, persistent ELII were detected using logistic regression analysis. Preoperative treatment of the IMA occlusion in patients with anatomical risk factors was performed to reduce ELII. ELII was detected in 48 patients (24.5%). Overall, patency of the IMA (odds ratio [OR], 4.13; P=0.004) and lumbar artery (LA) diameter ≥2.0mm (OR, 3.30; P=0.008) were significant risk factors for ELII, whereas an Endurant stent graft protected against ELII (OR, 0.22; P=0.023). However, in patients with patent IMA, IMA diameter ≥3.0mm (OR, 4.09; P=0.011), LA diameter ≥2.0mm (OR, 3.16; P=0.043), and aortoiliac aneurysm (OR, 6.36; P=0.026) were significant risk factors for ELII. Incidence rates of ELII in patients with and without these factors were 37.8% and 11.2%, respectively. ELII did not occur in patients with risk factors who underwent treatment of preoperative IMA occlusion. Patients with these risk factors are the candidates for undergoing treatment of preoperative IMA occlusion to reduce ELII.