Application Of Coils In Endovascular Aneurysm Repair For Abdominal Aortic Aneurysm Patients With High-risk Of Type? Endoleak

Objective:To explore the short-term benefit and feasibility of perigraft arterial sac embolization(PASE)with coils in endovascular aneurysm repair(EVAR)for abdominal aortic aneurysm(AAA)patients with high-risk of type II endoleak.Materials and Methods:All the subjects who underwent EVAR for AAA were selected from January 2013 to January 2017 at the First Affiliated Hospital of Fujian Medical University.A total of 141 patients who underwent EVAR were analyzed retrospectively,of which 67(47.5%)had at least two risk factors of type II endoleak,including absence of a circumferential thrombus,two or more pairs of patent lumbar arteries and developed lumbar arteries(average diameter> 2 mm),patent inferior mesenteric artery(IMA)and / or IMA with large diameter,deliberate covering the side of the internal iliac artery with stent-graft(SG)iliac branch without reconstruction,deliberate embolizing the side of the internal iliac artery with coils,giant aneurysmal cavity(AAA maximum outer diameter> 55 mm and / or complicated with iliac aneurysm).Those patients who met the inclusion criteria and underwent PASE at the same time were included in the study group,and the other cases before were included in the control group.To look for an endoleak and assess aneurysm sac diameter,we recommend preoperative and postoperative high resolution CTA.Those patients were performed with high resolution CTA and color duplex ultrasound imaging at 1,3,6,and 12 months later.The incidence of type endoleak and the reduction of aneurysm ?diameter were analyzed between the two groups to assess the difference of surgical methods.Results:A total of 67 AAA cases were identified as high-risk patients of type II endoleak,22 cases were included in the study group and 45 cases in the control group.An average of 2.1 ± 1.2 coils(1-5)were used in the study group.The follow-up period was 8 ± 4 months(from 6 months to 27 months).The technical success rate of the study group was 95.5% and the control group was 91.1%(P = 0.525).The clinical success rate was 86.4% for the study group and 73.3% for the control group(P = 0.230).The incidence of type ? endoleak was 13.6% for the study group and 17.6% for the control group(P = 0.017).The re-intervention rate was 9.1% for the study group and 26.7% for the control group(P = 0.010).The aneurysmal diameter in the study group decreased by 5.2 ± 3.6 mm(P <0.001),and 3.7 ± 2.0 mm in the control group(P <0.001).Conclusion : Application of perigraft arterial sac embolization with coils in endovascular aneurysm repair for abdominal aortic aneurysm patients with high-risk of type II endoleak is technically safe,feasible and effective.In the case of comprehensive with thorough of the economic status and anatomical condition,the method can be used as a supplement to EVAR to achieve rapid shrinkage of aneurysmal cavity,reduce the incidence of type ? endoleak,re-intervention rate and the risk of AAA rupture.