Frequency and Significance of Lumbar and Inferior Mesenteric Artery Perfusion after Endovascular Repair of Abdominal Aortic Aneurysms

Abstract

Purpose:

To evaluate the frequency and influence of perfused side branches (lumbar arteries [LA] and inferior mesenteric artery trunks) on development of type II endoleaks (EL-II) and on volume changes of abdominal aortic aneurysms (AAA) after endovascular repair.

Methods:

Of 114 patients undergoing EVR of AAA, 89 patients (83 men; mean age 72±7.5 years, range 51–88) with >6 months' follow-up and no type I endoleaks were retrospectively analyzed to determine any relationships between retrograde perfusion, endoleaks, and sac volume. Data were derived from computed tomographic angiographic (CTA) scans taken before and after intervention, at discharge, and at 1, 3, 6, and semi-annually thereafter in follow-up. Two groups were identified and compared based on their status at 6 months post EVR: without perfused side branches (group 1) and with perfused collaterals (group 2); group 2 was further divided according to the absence (2a) or presence (2b) of endoleak.

Results:

Median follow-up was 24 months (range 6–36). Based on a total of 582 CTAs analyzed, 17 (19%) patients developed type II endoleaks (EL-II) during follow-up. There was a significant difference in the number of perfused LAs prior to EVR between groups 1 (n=44) and the 45 patients with postprocedural patent collateral arteries in group 2 (p<0.05); there was no significant difference between groups 2a and 2b (p=0.88) relative to the number of pre-existing patent collaterals. The number of pLAs preoperatively and the rate of type II endoleak were significantly correlated (p<0.05). No type II endoleak was seen in patients without perfused side branches (p=0.01). No significant differences in mean volumes were found between groups 1 and 2a (no EL-II), but significant differences between groups 1 and 2b were seen in later follow-up.

Conclusions:

A larger number of patent LAs before EVR was associated with a significantly higher rate of type II endoleak. Patent collateral vessels were common after aneurysm repair, but the frequency decreased during follow-up. Persistent side branch perfusion was associated with increased type II endoleak after endovascular AAA repair. Significant differences in volume changes in later follow-up were seen between patients with or without type II endoleak.

Keywords

abdominal aortic aneurysm endovascular repair stent-graft endoleak lumbar arteries inferior mesenteric artery aneurysm volume computed tomographic angiography

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References

Chuter

TAM

Reilly

Faruqi

. Endovascular aneurysm repair in high-risk patients. J Vasc Surg. 2000; 31: 122–133.

White

May

. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: Classification, incidence, diagnosis, and management. J Endovasc Surg. 1997; 4: 152–168.

Wain

Marin

Ohki

. Endoleaks after endovascular graft treatment of aortic aneurysms: Classification, risk factors, and outcome. J Vasc Surg. 1998; 27: 69–80.

Armon

Yusuf

Whitaker

. Thrombus distribution and changes in aneurysm size following endovascular aortic aneurysm repair. Eur J Vasc Endovasc Surg. 1998; 16: 472–276.

Petrik

Moore

. Endoleaks following endovascular repair of abdominal aortic aneurysm: The predictive value of preoperative anatomic factors—a review of 100 cases. J Vasc Surg. 2001; 33: 739–744.

Karch

Henretta

Hodgson

. Algorithm for the diagnosis and treatment of endoleaks. Am J Surg. 1999; 178: 225–231.

Fan

Rafferty

Geller

. Endovascular stent-graft in abdominal aortic aneurysms: The relationship between patent vessels that arise from the aneurysmal sac and early endoleak. Radiology. 2001; 218: 176–182.

Haulon

Devos

Willoteaux

. Risk factors of early and late complications in patients undergoing endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2003; 25: 118–124.

Parent

Meier

Godziachville

. The incidence and natural history of type I and II endoleak: A 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg. 2002; 35: 474–481.

10.

Baum

Stavropoulos

Fairman

. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2003; 14: 1111–1117.

11.

Schurink

Aarts

van Bockel

. Endoleak after stent-graft treatment of abdominal aortic aneurysm: A meta analysis of clinical studies. Br J Surg. 1999; 86: 581–587.

12.

Schurink

Aarts

van Baalen

. Late endoleak after endovascular therapy for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 1999; 17: 448–450.

13.

Jacobowitz

Rosen

Riles

. The significance and management of the leaking endograft. Semin Vasc Surg. 1999; 12: 199–206.

14.

May

White

. Endovascular grafting for abdominal aortic aneurysms: Changing incidence and indications for conversion to open operation. Cardiovasc Surg. 1998; 6: 194–197.

15.

White

Donayre

Walot

. Abdominal aortic aneurysm rupture following endoluminal graft deployment: Report of a predictable event. J Endovasc Ther. 2000; 7: 257–262.

16.

Holzenbein

Kretschmer

Thurnher

. Midterm durability of abdominal aortic aneurysm endograft repair: A word of caution. J Vasc Surg. 2001; 33(2 Suppl): S46–54.

17.

White

May

Petrasek

. Endotension: An explanation for continued AAA growth after successful endoluminal repair. J Endovasc Surg. 1999; 6: 308–315.

18.

Broeders

IAMJ

Blankensteijn

Eikelboom

. The role of infrarenal aortic side branches in the pathogenesis of endoleaks after endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 1998; 16: 419–426.

19.

Görich

Rilinger

Sokiranski

. Endoleaks after endovascular repair of aortic aneurysm: Are they predictable? Initial results. Radiology. 2001; 218: 477–480.

20.

Bae

Heiken

Siegel

. Renal cysts: Is attenuation artifactually increased on contrast-enhanced CT images? Radiology. 2000; 216: 792–796.

21.

Walker

Halliday

Yusuf

. A study on the patency of the inferior mesenteric and lumbar arteries in the incidence of endoleak following endovascular repair of infrarenal aortic aneurysms. Clin Radiol. 1998; 53: 593–595.

22.

d'Audiffret

Desgranges

Kobeiter

. Follow-up evaluation of endoluminally treated abdominal aortic aneurysms with duplex ultrasonography: Validation with computed tomography. J Vasc Surg. 2001; 33: 42–50.

23.

Back

Bowser

Johnson

. Patency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair. Ann Vasc Surg. 2003; 17: 27–34.

24.

Kato

Semba

Dake

. Embolization of perigraft leaks after endovascular stent-graft treatment of aortic aneurysms. J Vasc Interv Radiol. 1996; 7: 805–811.

25.

Arko

Rubin

Johnson

. Type-II endoleaks following endovascular AAA repair: Preoperative predictors and long-term effects. J Endovasc Ther. 2001; 8: 503–510.

26.

Chuter

. The choice of stent-graft for endovascular repair of abdominal aortic aneurysm. J Cardiovasc Surg (Torino). 2003; 44: 519–525.

27.

Wolf

Tillich

Lee

. Changes in aneurysm volume after endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2002; 36: 305–309.

28.

Matsumura

Pearce

McCarthy

. Reduction in aortic aneurysm size: Early results after endovascular graft placement. J Vasc Surg. 1997; 25: 113–123.

29.

Resch

Ivancev

Lindh

. Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter. J Vasc Surg. 1998; 28: 242–249.

30.

Stonebridge

Draper

Kelman

. Growth rate of infrarenal aortic aneurysms. Eur J Vasc Endovasc Surg. 1996; 11: 70–73.

31.

White

Walot

Donayre

. Failed AAA endograft exclusion due to type II endoleak: Explant analysis. J Endovasc Ther. 2001; 8: 254–261.

32.

Solis

Ayerdi

Babcock

. Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization. J Vasc Surg. 2002; 36: 485–491.

33.

Bonvini

Alerci

Antonucci

. Preoperative embolization of collateral side branches: A valid means to reduce type II endoleaks after endovascular AAA repair. J Endovasc Ther. 2003; 10: 227–232.

34.

Maldonado

Gagne

. Controversies in the management of type II “branch” endoleaks following endovascular abdominal aortic aneurysm repair. Vasc Endovascular Surg. 2003; 37: 1–12.