Midterm Outcomes of Endoleak Type 2 Embolization after Endovascular Aortic Aneurysm Repair Using a Neurointerventional Approach.

BACKGROUND: Type 2 endoleaks (T2ELs) have been considered a benign condition and intervention is recommended when they are associated to sac expansion. The aim of this study was to report on T2EL embolization midterm outcomes, using neurointerventional material. METHODS: A single-center retrospective analysis of consecutive patients treated with transarterial embolization, using neurointerventional material, for T2EL after standard endovascular aortic aneurysm repair (EVAR) between January 01, 2017 and July 30, 2022, was undertaken. Primary outcome was technical success and secondary outcome was T2EL recurrence during follow-up. RESULTS: Twenty six patients [92.3% males, mean age 73.9 ± 7.7 years] were included. The median time between EVAR and T2EL diagnosis was 12 months (range: 1-84 months). In 38.5% of patients, T2EL was detected at first month after EVAR. The time to embolization was 18 months (range: 1-96 months). In 42.3% of cases, a patent inferior mesenteric artery was suspected to relate to T2EL formation while in 42.3% of cases, a lumbar artery. Twelve procedures (38.4%) were performed using coils and Onyx and 13 (50%), using only Onyx. Technical success was 84.6%. The mean follow-up was 24 months (range: 1-60 months), including 20 patients. In 30% of cases, an T2EL recurrence was detected. Three patients (11.5%) underwent secondary embolization. CONCLUSIONS: Transarterial embolization for T2EL, using neurointerventional material, provided acceptable technical success and T2EL recurrence rates at 2 years of follow-up. Longer follow-up data would further estimate the durability of the technique.

Color duplex ultrasonography of the superior mesenteric artery after placement of endografts with suprarenal stents.

After endovascular repair of abdominal aortic aneurysm with endografts with suprarenal stents, the proximal uncovered stent may cross the origin of the superior mesenteric artery. Effects on splanchnic circulation are unknown and may include development of stenosis at the vicinity of the stent. The criteria of high-grade superior mesenteric artery stenosis using color duplex ultrasonography have been previously reported. The purpose of this study is to examine the incidence of high-grade superior mesenteric artery stenosis in patients with endografts with suprarenal stents using color duplex ultrasonography. Candidates for the study were patients who had placement of an aortic endograft with a suprarenal stent and were able to undergo ultrasonography of the superior mesenteric artery. After reviewing computed tomography scans, patients who had the origin of the superior mesenteric artery crossed by the suprarenal stent underwent color duplex ultrasonography of this vessel. Presence of turbulence or narrowing of the superior mesenteric artery, or a peak systolic velocity greater than 2.75 m/sec, or an end-diastolic velocity greater than 0.45 m/sec were considered significant for the presence of high-grade superior mesenteric artery stenosis. There were 24 patients (21 males, three females), median age 71 years (range, 59-83). The suprarenal stent was crossing the superior mesenteric artery in 17 of 24 patients (71%). Color duplex ultrasound was technically successful in 13 of 17 (76%). The test was performed after a median follow-up of 9 months (range, 3 days to 34 months). No patient had evidence of turbulence or narrowing of the superior mesenteric artery during ultrasonography. The median peak systolic velocity was 0.92 m/sec (range, 0.53-1.21 m/sec). No patient had peak systolic velocity greater than 2.75 m/sec. The median end-diastolic velocity was 0.10 m/sec (range, 0.09-0.14 m/sec). No patient had end-diastolic velocity greater than 0.45 m/sec. Color duplex ultrasonography did not demonstrate the presence of high-grade superior mesenteric artery stenosis during early follow-up of patients with endografts with suprarenal stents. Longer follow-up of larger series of patients is needed to determine the long-term effects of suprarenal stents on splanchnic circulation.

Stent-graft migration after endovascular repair of abdominal aortic aneurysm.

PURPOSE: To report the incidence of graft migration in patients after endovascular repair of abdominal aortic aneurysms (AAA) and assess the significance of neck diameter changes in patients with and without suprarenal stent implantation. METHODS: The medical records and imaging studies of 176 consecutive patients (175 men; median age 71 years, range 48-88) who had endovascular AAA repair with the Nottingham aortomonoiliac system were reviewed. The following parameters were recorded: preoperative neck diameter and length, presence of intraoperative and late graft migrations, time to onset of late migration, length of late migration, and neck diameter changes in patients with documented late graft migration. The patients were divided into 2 groups based on the placement of an endograft with or without suprarenal bare stent fixation. Median follow-up was 15 months (range 1-48). RESULTS: There were 15 (8.5%) graft migrations (6 intraoperative and 9 late). Of those, 14 (10.9%) were in the 128-patient infrarenal fixation group and 1 (2.1%) in the 48-patient suprarenal stent group. Median neck diameters on preoperative and postoperative computed tomography scans in patients with late migration were 22.2 mm and 23.0 mm, respectively (p>0.05). The median time to graft migration was 14 months after the original operation (range 6-36). CONCLUSIONS: Distal device migration occurred frequently with the Nottingham system. Late graft migration was not associated with neck enlargement. Endografts with a suprarenal stent may have a decreased incidence of graft migration.