Operative Treatment of Type 2 Endoleaks Involving the Inferior Mesenteric Artery

Abstract

We report the results of the operative treatment for type 2 endoleak (T2E) involving the inferior mesenteric artery (IMA) using the transarterial embolization (TAE) or the video laparoscopic ligation (VLS). Between January 2005 and December 2015, we retrospectively analyzed 901 patients treated with endovascular aortic repair (EVAR): 883 (98%) had 1 valid postoperative radiologic evaluation, at least. All patients with operative repair for IMA-related T2E entered the final analysis. Indication of their operative repair was sac enlargement (>5mm within 6months or >1cm from the preoperative diameter, irrespectively of the postoperational time) and/or its persistence >12months. We detected 192 (21.7%) T2Es, overall. We identified 37 (4.2%) IMA-related T2Es, and treated 21 cases (VLS n=11, TAE n=10). Aneurysm-related mortality and major or minor morbidity was never observed. Time of intervention did not differ significantly (minutes, VLS=97±46 vs. TAE=95±21, P=0.901). Hospitalization was significantly lower in the TAE group (days, 4±2 vs. 1 ±0.4, P<0.001). No patient was lost at a mean follow-up of 46±32months (range, 1-110; median, 48). At last follow-up, sac diameter was significantly more stable in the VLS (mm, 60±10 vs. 55 ±7, P=0.593) than that in the TAE group (mm, 57±9 vs. 63 ±10, P=0.050). The IMA-related T2E reintervention rate was not significantly different between the groups (VLS, n=0 [0%] vs. TAE, n=2 [20.0%], P=0.213). Secondary aortic reintervention rate was 28.6% (n=6), and secondary open conversion rate was 9.5% (VLS, n=1 [9.1%] vs. TAE, n=1 [10.0%], P=1). In authors' experience, operative treatment of IMA-related T2E was safe; VLS proved to be effective and durable in sealing this type of T2E. Patients receiving correction of IMA-related T2E after EVAR remained at risk for development of any type of endoleaks, as well as at risk of reintervention.