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• W4280491187 abstract "We previously demonstrated the efficacy of endovascular aortic aneurysm repair (EVAR) using concomitant n-butyl-2-cyanoacrylate (NBCA) injection into the abdominal aortic aneurysm sac to prevent a type II endoleak (T2E) from lumbar arteries. Although T2E as the leading cause of secondary interventions was under control, EVAR, even without a type I endoleak, does not guarantee satisfactory mid-term outcomes. The aim of this study was to report our intraoperative T2E management and propose the next target to reduce secondary interventions following EVAR. Intraoperative management to prevent T2E was introduced in October 2015 at our facility. Our strategy was as follows. First, the tip of the catheter was inserted into the aneurysm sac after embolization of the inferior mesenteric artery. Next, intraoperative angiography of the aneurysm sac was performed after deploying the stent graft. Finally, if the lumbar artery was confirmed, NBCA was injected to prevent a T2E (Fig). We investigated the postoperative enlargement of the aneurysm for ≥1 after EVAR until December 2020. Exclusion criteria included patients with residual type I or III endoleak intraoperatively, cases in which it was not feasible to insert the catheter into the aneurysm sac before deploying the stent graft, cases in which the lumbar artery was not confirmed by preoperative contrast-enhanced computed tomography, and redo cases. Postoperative endoleak was determined using contrast-enhanced computed tomography and ultrasound. EVAR with intraoperative T2E management was performed in 160 cases. The average patient age was 76.5 ± 7.8 years, and 128 patients were men (80.0%). The average maximum short axis of the abdominal aortic aneurysm was 51.1 ± 10.1 mm. NBCA injection was performed in 137 cases (85.6%). Although five patients (3.1%) had exhibited a T2E at 1 week postoperatively, none had required secondary interventions. The median follow-up period was 2.4 years (interquartile range, 1.4-3.5 years). Six patients (3.8%) had required repeat EVAR because of aneurysm enlargement caused by de novo endoleaks, including type Ib endoleak (1 case; 0.6%), type IIIa endoleak (1 case; 0.6%), and type IIIb endoleak (4 cases; 2.5%). The rate of freedom from postoperative repeat EVAR was 100% at 1 year and 97.5% at 3 years. Intraoperative management for T2E in our facility reduced the incidence of secondary interventions. Type IIIb endoleak might be the next concern in T2E-free EVAR." @default.
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• W4280491187 date "2022-06-01" @default.
• W4280491187 modified "2023-09-26" @default.
• W4280491187 title "Type IIIb Endoleak Might Be the Next Concern in Cases of EVAR Without Type II Endoleak" @default.
• W4280491187 doi "https://doi.org/10.1016/j.jvs.2022.03.245" @default.
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