Introduction:

type II endoleak (T2EL), through the inferior mesenteric artery (IMA) or lumbar arteries (LA), is the most common endoleak after endovascular abdominal aortic aneurysm repair (EVAR).

Objectives:

the primary endpoint was the presence of type II endoleak at follow-up. Secondary endpoints included aneurysm sac regression and reoperation rate due to T2EL, as well as the analysis of the results in our series of cases treated with IMA embolization prior to the endovascular procedure as a useful method to reduce T2EL at follow-up.

Material and methods:

this was a retrospective analysis of patients treated at our unit with IMA embolization prior to EVAR from 2019 through 2021. The criteria used for IMA embolization were IMA diameter > 3 mm, presence of LA with a diameter > 2 mm, or aortoiliac aneurysms. A total of 7 male patients were included with a mean age of 72.1 years. A total of 42 % had aortoiliac aneurysms. In 2 of the cases, IMA embolization was performed initially followed by EVAR while in the remaining cases it was performed within the same procedure. The mean diameter of IMA was 5.02 mm ± 0.9 mm. All patients had at least 2 LAs facing the origin of the IMA with a diameter > 2 mm.

Results:

technical success was 100 %. The median follow-up was 20.7 months. In the CCTA performed 1 month and 12 months postoperatively, correct IMA embolization was observed. There were no type II leaks at follow-up. In all cases, a decrease in the diameter of the aneurysmal sac was observed with a mean regression of 5.08 mm. There were no subsequent reinterventions associated with aortic valve disease.

Conclusions:

IMA embolization prior to EVAR in patients with a diameters > 3 mm and the presence of at least 2 ALs with diameters > 2 mm and/or aortoiliac aneurysms seems to protect against the development of T2EL at 12 months, waiting to be able to confirm the results in the mid- and long-term with high technical success and an acceptable regression of the aneurysmal sac.

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