From the Research
Variations in abdominal aorta branches, particularly the presence of a patent inferior mesenteric artery (IMA) with a diameter greater than 2.6mm and multiple patent lumbar arteries, significantly increase the risk of type 2 endoleaks after Endovascular Aneurysm Repair (EVAR). The risk of type 2 endoleaks is substantially higher in patients with a greater number of patent aortic side branches, especially those with diameters exceeding 2mm 1.
Key Factors Influencing Type 2 Endoleak Risk
- The presence of a patent IMA with a diameter greater than 2.6mm is a powerful risk factor for type 2 endoleaks 1.
- The number of patent lumbar arteries and their diameter also play a significant role, with each additional lumbar artery branch ≥1.9mm increasing the risk 1.
- A circumferential thrombus is a protective factor against type 2 endoleaks, whereas an IMA ≥2.6mm and each additional LA branch ≥1.9mm are risk factors 1.
Implications for Clinical Practice
- Preoperative evaluation of abdominal aorta branches using CT angiography is crucial to identify high-risk patients 1.
- For high-risk patients, preventive measures like preoperative embolization of large side branches or more frequent post-EVAR surveillance may be warranted to detect and address endoleaks early 2, 3.
- Translumbar embolization is a safe and effective treatment option for type 2 endoleaks with aneurysm growth following EVAR, with a higher success rate and lower risk of complications compared to transarterial embolization 3, 4.
Recommendations
- Careful evaluation of abdominal aorta branches on pre-operative CT angiography is essential to predict the risk of type 2 endoleaks.
- High-risk patients should be considered for preventive measures or closer surveillance to minimize the risk of type 2 endoleaks and potential complications.
- Translumbar embolization should be considered as a treatment option for type 2 endoleaks with aneurysm growth, given its higher success rate and lower risk of complications.