Operative Treatment Of Type 2 Endoleaks Involving The Inferior Mesenteric Artery

We report the results of the operative treatment for type 2 endoleak (T2E) involving the inferior mesenteric artery (IMA) using the transarterial embolization (TAE) or the video-laparoscopic ligation (VLS). METHODS: Between January 2005 and December 2015, we retrospectively analyzed 901 patients treated with endovascular aortic repair (EVAR): 883 (98%) had one valid postoperative radiologic evaluation, at least. All patients with operative repair for IMA-related T2E entered the final analysis. Indication of their operative repair was: sac enlargement (>5mm within 6 months or >1cm from the preoperative diameter, irrespectively of the post-operational time) and/or its persistence >12 months. RESULTS: We detected 192 (21.7%) T2Es, overall. We identified 37 (4.2%) IMA-related T2Es, and treated 21 cases (VLS n = 11, TAE n = 10). Aneurysm-related mortality and major or minor morbidity was never observed. Time of intervention did not differ significantly (minutes, VLS = 97 ± 46 vs. TAE = 95 ± 21, P = .901). Hospitalization was significantly lower in the TAE group (days, 4 ± 2 vs. 1 ± 0.4, P < .001). No patient was lost at a mean follow-up of 46 ± 32 months (range, 1-110; median, 48). At last follow-up, sac diameter was significantly more stable in the VLS (mm, 60 ± 10 vs. 55 ± 7, P = .593) than in the TAE group (mm, 57 ± 9 vs. 63 ± 10, P = .050). The IMA-related T2E reintervention rate was not significantly different between the groups [VLS, n = 0 (0%) vs. TAE, n = 2 (20.0%), P = .213]. Secondary aortic reintervention rate was 28.6% (n = 6), and secondary open conversion rate was 9.5% [VLS, n = 1 (9.1% vs. TAE, n = 1 (10.0%), P = 1]. CONCLUSION: In Authors' experience, operative treatment of IMA-related T2E was safe; VLS proved to be effective and durable in sealing this type of T2E. Patients receiving correction of IMA-related T2E after EVAR remained at risk for development of any type of endoleaks, as well as at risk of reintervention.