Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202201372
Jornal Vascular Brasileiro
Review Article

Safety of preoperative branch embolization in patients undergoing evar

Segurança da embolização pré-operatória do ramo em pacientes submetidos a evar

Luis Ángel Suárez González; Iñigo Lozano Martínez-Luengas; Pablo del Canto Peruyera; Manuel Javier Vallina-Victorero Vazquez

Downloads: 1
Views: 725

Abstract

The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

Keywords

EVAR, inferior mesenteric artery, lumbar arteries, embolization

Resumo

O objetivo desta revisão sistemática foi avaliar a segurança da embolização de artéria mesentérica inferior (AMI) e artérias lombares (ALs) pré-correção endovascular de aneurisma da aorta abdominal. Foram realizadas pesquisas nas bases de dados MEDLINE e Dimensions. Foram encontrados 9 estudos publicados de 2011 a 2021 que atendiam aos critérios de inclusão e exclusão. Os estudos foram analisados ​​para definir a incidência de complicações relacionadas à embolização. No total, 482 pacientes foram submetidos a embolização de AMI e/ou ALs, dos quais 30 (6,2%) sofreram algum tipo de complicação menor. A única complicação importante observada foi colite isquêmica em 4 (0,82%) pacientes. Dois (0,41%) desses pacientes morreram após cirurgia de ressecção intestinal. Em relação a esses achados, a embolização de AMI e ALs parece ser um procedimento seguro, com um percentual muito baixo de complicações menores e importantes.

Palavras-chave

EVAR, artéria mesentérica inferior, artérias lombares, embolização

References

1 Parodi JC, Palmaz JC, Barone HD. Transfemoral Intraluminal Graft Implantation for Abdominal Aortic Aneurysms. Ann Vasc Surg. 1991;5(6):491-9. http://dx.doi.org/10.1007/BF02015271. PMid:1837729.

2 Greenhalgh RM, Brown LC, Kwong GPS, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet Lond Engl. 2004;364(9437):843-8. http://dx.doi.org/10.1016/S0140-6736(04)16979-1. PMid:15351191.

3 Conrad MF, Adams AB, Guest JM, et al. Secondary intervention after endovascular abdominal aortic aneurysm repair. Ann Surg. 2009;250(3):383-9. http://dx.doi.org/10.1097/SLA.0b013e3181b365bd. PMid:19652592.

4 Columbo JA, Kang R, Hoel AW, et al. A comparison of reintervention rates after endovascular aneurysm repair between the Vascular Quality Initiative registry, Medicare claims, and chart review. J Vasc Surg. 2019;69(1):74-79.e6. http://dx.doi.org/10.1016/j.jvs.2018.03.423. PMid:29914838.

5 Dijkstra ML, Zeebregts CJ, Verhagen HJM, et al. Incidence, natural course, and outcome of type II endoleaks in infrarenal endovascular aneurysm repair based on the ENGAGE registry data. J Vasc Surg. 2020;71(3):780-9. http://dx.doi.org/10.1016/j.jvs.2019.04.486. PMid:31443976.

6 Mulay S, Geraedts ACM, Koelemay MJW, et al. Type 2 endoleak with or without intervention and survival after endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2021;61(5):779-86. http://dx.doi.org/10.1016/j.ejvs.2021.01.017. PMid:33632609.

7 Velazquez OC, Baum RA, Carpenter JP, et al. Relationship between preoperative patency of the inferior mesenteric artery and subsequent occurrence of type II endoleak in patients undergoing endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000;32(4):777-88. http://dx.doi.org/10.1067/mva.2000.108632. PMid:11013042.

8 Suárez González LÁ, Lozano Martínez-Luengas I, Montoya Calzada N, Fernández-Samos Gutiérrez R, Vallina-Victorero Vázquez MJ. Preoperative predictive factors for type II endoleak: trying to define high-risk patients. Asian J Surg. 2023;46(1):187-91. http://dx.doi.org/10.1016/j.asjsur.2022.03.022. PMid:35317967.

9 Ito T, Kurimoto Y, Kawaharada N, et al. Ischemic colitis following transarterial embolization for type 2 endoleak of EVAR: report of a case. Ann Vasc Dis. 2012;5(1):92-5. http://dx.doi.org/10.3400/avd.cr.11.00081. PMid:23555495.

10 Lanza E, Poretti D, Tramarin M, Pedicini V, Balzarini L. Colonic ischemia, perforation, and colectomy after a complicated endovascular embolization for type II endoleak with the use of cyanoacrylate glue. J Vasc Interv Radiol JVIR. 2014;25(9):1482-4. http://dx.doi.org/10.1016/j.jvir.2014.05.018. PMid:25150908.

11 Sanz-Sánchez J, Poretti D, Poletto G, Civilini E. Paraplegia due to spinal cord ischemia after endovascular treatment of a type II Endoleak. Ann Vasc Surg. 2019;61:472.e1. http://dx.doi.org/10.1016/j.avsg.2019.05.054. PMid:31394248.

12 Gaudry M, Lagier D, Brige P, et al. Onyx migration into the anterior spinal artery during lumbar artery embolisation: an adverse event. EJVES Short Rep. 2018;39:20-3. http://dx.doi.org/10.1016/j.ejvssr.2018.04.001. PMid:29988815.

13 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097. PMid:19621072.

14 Lopera JE. The amplatzer vascular plug: review of evolution and current applications. Semin Intervent Radiol. 2015;32(4):356-69. http://dx.doi.org/10.1055/s-0035-1564810. PMid:26622098.

15 Burbelko M, Kalinowski M, Heverhagen JT, et al. Prevention of Type II endoleak using the AMPLATZER vascular plug before endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2014;47(1):28-36. http://dx.doi.org/10.1016/j.ejvs.2013.10.003. PMid:24183247.

16 Aoki A, Maruta K, Hosaka N, Masuda T, Omoto T, Horikawa Y. Predictive factor of the possibility for aortic side branches coil embolization during endovascular abdominal aortic aneurysm repair. Ann Vasc Dis. 2020;13(3):240-7. http://dx.doi.org/10.3400/avd.oa.20-00115. PMid:33384725.

17 Alerci M, Giamboni A, Wyttenbach R, et al. Endovascular abdominal aneurysm repair and impact of systematic preoperative embolization of collateral arteries: endoleak analysis and long-term follow-up. J Endovasc Ther Off J Int Soc Endovasc Spec. 2013;20(5):663-71. http://dx.doi.org/10.1583/12-4188MR.1. PMid:24093319.

18 Petit P, Hertault A, Mesnard T, et al. Outcomes of preventive embolization of the inferior mesenteric artery during endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol. 2021;32(9):1360-1370.e2. http://dx.doi.org/10.1016/j.jvir.2021.05.023. PMid:34087358.

19 Branzan D, Geisler A, Steiner S, et al. Type II endoleak and aortic aneurysm sac shrinkage after preemptive embolization of aneurysm sac side branches. J Vasc Surg J (NY). 2021;73(6):1973-1979.e1. PMid:33278537.

20 Müller-Wille R, Uller W, Gössmann H, et al. Inferior mesenteric artery embolization before endovascular aortic aneurysm repair using amplatzer vascular plug type 4. Cardiovasc Intervent Radiol. 2014;37(4):928-34. http://dx.doi.org/10.1007/s00270-013-0762-4. PMid:24170169.

21 Ward TJ, Cohen S, Fischman AM, et al. Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol JVIR. 2013;24(1):49-55. http://dx.doi.org/10.1016/j.jvir.2012.09.022. PMid:23273697.

22 Vaillant M, Barral PA, Mancini J, 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. http://dx.doi.org/10.1016/j.avsg.2019.03.012. PMid:31200030.

23 Manunga JM, Cragg A, Garberich R, et al. Preoperative inferior mesenteric artery embolization: a valid method to reduce the rate of type II endoleak after EVAR? Ann Vasc Surg. 2017;39:40-7. http://dx.doi.org/10.1016/j.avsg.2016.05.106. PMid:27531083.

24 Abularrage CJ, Crawford RS, Conrad MF, et al. Preoperative variables predict persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg. 2010;52(1):19-24. http://dx.doi.org/10.1016/j.jvs.2010.02.023. PMid:20478685.

25 Samura M, Morikage N, Mizoguchi T, et al. Identification of anatomical risk factors for type ii endoleak to guide selective inferior mesenteric artery embolization. Ann Vasc Surg. 2018;48:166-73. http://dx.doi.org/10.1016/j.avsg.2017.10.016. PMid:29275128.

26 Couchet G, Pereira B, Carrieres C, et al. Predictive factors for type ii endoleaks after treatment of abdominal aortic aneurysm by conventional endovascular aneurysm repair. Ann Vasc Surg. 2015;29(8):1673-9. http://dx.doi.org/10.1016/j.avsg.2015.07.007. PMid:26303269.

27 Seike Y, Matsuda H, Fukuda T, et al. The influence of 4 or more patent lumbar arteries on persistent type II endoleak and sac expansion after endovascular aneurysm repair. Ann Vasc Surg. 2018;50:195-201. http://dx.doi.org/10.1016/j.avsg.2017.12.014. PMid:29501597.

28 Kondov S, Dimov A, Beyersdorf F, et al. Inferior mesenteric artery diameter and number of patent lumbar arteries as factors associated with significant type 2 endoleak after infrarenal endovascular aneurysm repair. Interact Cardiovasc Thorac Surg. 2022;35(1):16. http://dx.doi.org/10.1093/icvts/ivac016. PMid:35425973.

29 Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2. http://dx.doi.org/10.1016/j.jvs.2017.10.044. PMid:29268916.

30 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.

31 Ultee KHJ, Büttner S, Huurman R, et al. Editor’s Choice – Systematic review and meta-analysis of the outcome of treatment for type II endoleak following endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2018;56(6):794-807. http://dx.doi.org/10.1016/j.ejvs.2018.06.009. PMid:30104089.

32 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. 2020;72(5):1783-1792.e1. http://dx.doi.org/10.1016/j.jvs.2020.05.020. PMid:32442608.

33 Ichihashi S, Takahara M, Fujimura N, et al. Multicentre randomised controlled trial to evaluate the efficacy of pre-emptive inferior mesenteric artery embolisation during endovascular aortic aneurysm repair on aneurysm sac change: protocol of Clarify IMA study. BMJ Open. 2020;10(2):e031758. http://dx.doi.org/10.1136/bmjopen-2019-031758. PMid:32066599.

34 Ioannou CV, Tsetis DK, Kardoulas DG, Katonis PG, Katsamouris AN. Spinal cord ischemia after endovascular embolization of a type II endoleak following endovascular aneurysm repair. Ann Vasc Surg. 2012;26(6):860.e1-7. http://dx.doi.org/10.1016/j.avsg.2011.12.018. PMid:22794340.

35 Aday U, Gundes E, Cetin DA, et al. Ischemic colitis following infrarenal abdominal aortic aneurysm treatment: Results from a tertiary medical center. North Clin Istanb. 2018;5(3):221-6. PMid:30688933.

36 Moghadamyeghaneh Z, Sgroi MD, Chen SL, Kabutey NK, Stamos MJ, Fujitani RM. Risk factors and outcomes of postoperative ischemic colitis in contemporary open and endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2016;63(4):866-72. http://dx.doi.org/10.1016/j.jvs.2015.10.064. PMid:26747680.

37 Shrivastava S, Shrivastava S, Avula SNA, et al. Emphasis on early identification of risk factors to curtail high mortality involved with Ischemic Colitis (IC) After Abdominal Aortic Aneurysm (AAA) repair. Cureus. 2022;14(3):e23492. http://dx.doi.org/10.7759/cureus.23492. PMid:35503664.

38 Gabel J, Teruya T, Bianchi C, Kiang SC, Patel S, Abou-Zamzam AM Jr. Ischemic colitis after translumbar n-butyl cyanoacrylate injection for treatment of endoleak. J Vasc Surg Cases Innov Tech. 2018;4(3):238-9. http://dx.doi.org/10.1016/j.jvscit.2018.04.003. PMid:30175300.
 


Submitted date:
06/12/2023

Accepted date:
11/08/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
65d4ea29a953957c43022a02 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections