Vascular surgical society of great britain and ireland: prevention of lumbar artery endoleaks following endovascular abdominal aortic aneurysm repair with the selective use of absorbable gelatin sponge

Abstract

BACKGROUND: The aim of endovascular repair of an abdominal aortic aneurysm is to exclude the aneurysm from the systemic circulation in order to prevent aneurysm expansion and rupture. Lumbar artery (LA) endoleaks have been associated with continued expansion of the aneurysm sac and occur with a reported incidence of approximately 10 per cent. The aim of this study was to reduce the incidence of LA or inferior mesenteric artery (IMA) endoleaks. METHODS: Following deployment of an aortic uni-iliac graft an aneurysmograph was performed by injecting contrast into the aneurysm sac to look for patent aortic side branches. Patients with no visible side branches had an occluder deployed in the contralateral iliac artery. Patients with patent side branches had an absorbable gelatin sponge inserted into the aneurysm sac before occluder deployment. Patients had contrast-enhanced spiral computed tomography (CT) during follow-up at 1 week, and 3, 6 and 12 months. RESULTS: Fifty-four patients were studied. Eleven were excluded (two perioperative deaths, seven top endoleaks and two occluder endoleaks). Median follow-up was 2 (range 11-7) months. Of the 17 patients in whom patent vessels were demonstrated on an aneurysmograph, one had a patent IMA only, three had a patent LA and IMA, and the remainder had a patent LA. No patient within the study has had a LA or IMA endoleak identified at follow-up CT. CONCLUSION: An intraoperative aneurysmograph can help select patients for aneurysm sac packing with gelatin sponge and has been successful in the short term in preventing LA and IMA endoleaks.