Michele Piazza1, Paola Scrivere1, Michele Antonello1, Stefano Bonvini1, Alberto Dall'Antonia1, Franco Noventa4, Joseph J. Ricotta3, Franco Grego1, Paolo Frigatti2
1Vascular and Endovascular Surgery, Padova University, Padova, Italy; 2Vascular and Endovascular Surgery, Udine Clinic, Udine, Italy; 3Vascular and Endovascular Surgery, Emory Clinic, Atlanta, GA; 4Clinic of Medicine IV, Padova University, Padova, Italy.
OBJECTIVES: To evaluate the role of intraoperative aneurysm sac embolization during EVAR (edEVAR) with coils and glue, in the prevention of Endoleak type II (ET2).
METHODS: Two groups were compared: 85 patients underwent standard EVAR during 2007-2008 (Group A) and 81 patients underwent edEVAR during 2009-2010 (Group B). CT scans were elaborated with the Osirix 4.0 software in order to obtain aneurysm sac volume. ET2 rates at the first CT scan follow-up, as mid-term free from ET2 and free from related reintervention were compared. Preoperative patent number of aortic side branches (IMA, lumbars, accessories renal), thrombus and sac volume were evaluated for their association with ET2 in the two groups, using multivariate analysis.
RESULTS: Patients characteristics, Society for Vascular Surgery (SVS) comorbidity score (0.85±0.44 vs. 0.82±0.48; p=.68) and operative time (185.4±51.8 vs. 172.9±50.8; p=.99) were similar between group A and B. The first CT scan (<or= 2 months) demonstrated significantly higher number of ET2 in group A compared to group B (23.5% vs. 9.8%; p=.02). Spontaneous ET2 resolution occurred in 65% of patients in Group A and 79% in group B (p=1.0), while sac volume increased in 25% vs. 10% (p=.63) of cases respectively. At 18 months (range: 6 to 24) overall mean difference in sac volume shrinkage (27.2±12.3 cm3 vs. 24.8±11.6 cm3; p=.19) and free from ET2 (91.8% vs. 96.3%; p=0.33) were similar, while free from reintervention was significantly lower in Group A (94.1% vs. 98.8%, p=.05) compared to Group B. Multivariate analysis showed preoperative aneurysm sac volume > 125 cm3 to be the only independent significant predictor of ET2 (OR, 3.64; 95% CI, 1.54 to 8.58; p=.003).
CONCLUSIONS: EdEVAR seems to be a valid approach to prevent ET2 and its complications during short and mid-term follow-up. Patients with preoperative aneurysm sac volume higher than 125 cm3 should be considered for a more aggressive intraoperative embolization.
AUTHOR DISCLOSURES: M. Antonello, Nothing to disclose; S. Bonvini, Nothing to disclose; A. Dall'Antonia, Nothing to disclose; P. Frigatti, Nothing to disclose; F. Grego, Nothing to disclose; F. Noventa, Nothing to disclose; M. Piazza, Nothing to disclose; J. J. Ricotta, Nothing to disclose; P. Scrivere, Nothing to disclose.
Posted April 2012