P-020 - PRE-EMPTIVE EMBOLIZATION OF AORTIC SIDE BRANCHES PRIOR TO ENDOVASCULAR AORTIC REPAIR TO PREVENT TYPE II ENDOLEAKS: THE 2022 UPDATE FROM A PREVIOUS SYSTEMATIC REVIEW AND META-ANALYSIS

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Yu H.Y.H. (Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Lindström D. (Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Wanhainen A. (Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Tegler G. (Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Hassan B. (Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Mani K. (Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden)
Introduction:
Type II endoleaks is the commonest complication after endovascular aortic repair (EVAR), which may result in sac expansion and rupture. Previous systematic review and meta-analysis confirmed pre-emptive embolization of aortic side branches prior to EVAR reduces sac size enlargement, incidence of type II endoleaks and its related reintervention. However, its sample size was small and the level of evidence of the included studies were not strong. Recently, some key studies have been published, which justifies and update of the previous meta-analysis.
Methods:
With reference to a systematic review & meta-analysis performed in 2019, the MEDLINE database was used to search for related articles from January 2019 till March 2022. Search algorithm is identical to the previous study. After screening, original studies reporting outcome of pre-emptive embolization of aortic side branches were included in this review.
Results:
13 retrospective cohort studies were obtained from the previous meta-analysis. 4 new studies were identified after screening 741 publications, including one randomized controlled study, one nation-wide database study and one study including fenestrated EVAR. In the seventeen studies, 17,015 patients were included, comparing pre-emptive embolization (n=1,007) to standard EVAR therapy (n=16,008). Technical success of embolization was 81.6% (346/424). There was one reported mortality related to embolization in a patient with previous colectomy. Based on the sixteen studies, the incidence of type II endoleaks was 19.7% in the embolization group vs. 37.4% in the control group, odds ratio 0.38 (95%CI 0.30 - 0.47) (figure 1). Based on twelve studies, the incidence of reintervention for type II endoleaks was 1.2% in the embolization group vs. 11.2% in the control group, odds ratio 0.12 (95%CI 0.06 - 0.23). From ten studies, the incidence of sac size enlargement was 4.3% in the embolization group vs. 6.9% in the control group, odds ratio 0.38 (95% 0.26-0.55) (figure 2).
Conclusion:
This update confirmed the potential of pre-emptive embolization of aortic side branches prior to EVAR in reducing incidence of reintervention for type II endoleaks and sac size enlargement. Studies with higher level of evidence and nation-wide database were included, improving the quality of this meta-analysis. Multi-center, randomized evidence on long-term clinical outcome is needed for definitive conclusions.
References:
1. Yu HYH, Lindström D, Wanhainen A, Tegler G, Hassan B, Mani K. Systematic review and meta-analysis of prophylactic aortic side branch embolization to prevent type II endoleaks. J Vasc Surg 2000;72:1783-92). 2. Vaillant M, Barral PA, Mancini J, de Masi M, Bal L, et al. Preoperative inferior mesenteric artery embolization is a cost-effective technique that may reduce the rate of aneurysm sac diameter enlargement and reintervention after EVAR. Ann Vasc Surg 2019;60:85-94. 3. Samura M, Morikage N, Otsuka R, Mizoguchi T, Takeuchi Y, Nagase T, et al. Endovascular aneurysm repair with inferior mesenteric artery embolization for preventing type II endoleak: a prospective randomized controlled trial. Ann Surg 2020;271:238-44. 4. Petit P, Hertault A, Mesnard , Bianchini A, Lopez B, Patterson BO, et al. Outcomes of preventive embolization of the inferior mesenteric artery during endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol 2021;32:1360-70. 5. Rokosh RS, Chang H, Butler JR, Bockman CB, Patel VI, Milner R, et al. Prophylactic sac outflow vessel embolization is associated with improved sac regression in patients undergoing endovascular aortic aneurysm repair. J Vasc Surg 2021 Dec 17;S0741-5214(21)02607-0.
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