Outcomes of Preventive Embolization of the Inferior Mesenteric Artery during Endovascular Abdominal Aortic Aneurysm Repair |
| |
Affiliation: | 1. Vascular Surgery, Aortic Centre, Université de Lille, CHU Lille, F-59000 Lille, France;2. Université de Lille, INSERM, CHU Lille, U1008 – Controlled Drug Delivery Systems and Biomaterials, Lille, France;3. Vascular Surgery, CH Valenciennes, Valenciennes, France;4. Medical Laboratory, Dunkerque Hospital, Dunkerque, France;5. Department of Vascular Surgery, University Hospital Southampton, Southampton, United Kingdom;6. Aortic Centre, Groupe Hospitalier Paris Saint Joseph, Hôpital Marie-Lannelongue, Université Paris Saclay, Le Plessis-Robinson, France |
| |
Abstract: | PurposeTo evaluate the impact of preemptive inferior mesenteric artery (IMA) embolization on outcomes of endovascular abdominal aortic aneurysm (AAA) repair (EVAR).Materials and MethodsFrom January 2015 to July 2017, all patients undergoing elective EVAR or fenestrated EVAR (F-EVAR) for asymptomatic AAA in a single tertiary hospital were retrospectively included. Three groups of patients were defined: patients with a patent IMA who underwent embolization during EVAR/F-EVAR (group 1), those with a patent IMA who did not undergo embolization during EVAR/F-EVAR (group 2), and those with a chronically occluded IMA (group 3). Preoperative aortic morphology, demographics, and procedural details were recorded. Aneurysmal growth (≥5 mm), reintervention, and overall mortality rates were analyzed using multivariate proportional hazard multivariate modeling. Propensity scores were constructed, and inverse probability weighting was applied to a new set of multivariate analyses to perform a sensitivity analysis.ResultsA total of 266 patients (male, 95% [n = 249]) with a median age of 70 (65–77) years were included, with F-EVAR procedures comprising 87 (32.7%) of the interventions. There were 52, 142, and 72 patients in groups 1, 2, and 3, respectively. Changes in aneurysmal sac size did not differ between groups, nor did overall survival or reintervention rates at 24 months. IMA embolization was not identified as an independently protective factor for aneurysmal growth during follow-up (relative risk [RR] = 2.82/mm [0.96–8.28], P = .060), whereas accessory renal arteries (RR = 5.07/mm [1.72–14.96], P = .003) and a larger preoperative aneurysmal diameter (RR = 1.09/mm [1.03–1.15], P = .004) were independent risk factors for sac enlargement.ConclusionsPreventive embolization of the IMA during EVAR or F-EVAR did not promote aneurysmal sac shrinking or decrease the reintervention rate at 2-year follow-up. |
| |
Keywords: | AAA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0015" }," $$" :[{" #name" :" text" ," _" :" abdominal aortic aneurysm CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0025" }," $$" :[{" #name" :" text" ," _" :" computed tomography EL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" endoleak EVAR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" endovascular abdominal aortic aneurysm repair F-EVAR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" fenestrated endovascular abdominal aortic aneurysm repair IMA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" inferior mesenteric artery RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" randomized controlled trial RR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" relative risk T2EL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" type II endoleak |
本文献已被 ScienceDirect 等数据库收录! |
|