Prophylactic Intraoperative Embolization of Abdominal Aortic Aneurysm Sacs Using N-Butyl Cyanoacrylate/Lipiodol/Ethanol Mixture with Proximal Neck Aortic Balloon Occlusion during Endovascular Abdominal Aortic Repair

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• 作者：Motoki Nakai ; MD ; PhD^a ; ^{momonga@wakayama-med.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Akira Ikoma ; MD ; PhD^a ; Morio Sato ; MD ; PhD^a ; Hirotatsu Sato ; MD^a ; Yoshiharu Nishimura ; MD ; PhD^b ; Yoshitaka Okamura ; MD ; PhD^b
• 关键词：AAA ; abdominal aortic aneurysm ; AKA ; Adamkiewicz artery ; EVAR ; endovascular aneurysm repair ; IFU ; instructions for use ; IMA ; inferior mesenteric artery ; NBCA ; N-butyl cyanoacrylate ; NLE ; N-butyl cyanoacrylate/Lipiodol/ethanol ; SPI ; systolic sac pressure index
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：27
• 期：7
• 页码：954-960
• 全文大小：1012 K

文摘

To determine the feasibility of prophylactic intraoperative abdominal aortic aneurysm (AAA) sac embolization using a mixture of N-butyl cyanoacrylate/Lipiodol/ethanol (NLE) with proximal neck aortic balloon occlusion during endovascular aneurysm repair (EVAR) to prevent the occurrence of endoleak and aneurysm sac expansion.

Materials and Methods

Prophylactic intraoperative AAA sac embolization was performed in 24 patients with an infrarenal neck angulation > 60° (n = 16) or AAA sac diameter > 60 mm (n = 17). AAA sac pressure was continuously measured with a 3-F catheter inserted into the AAA sac. The systolic sac pressure index (SPI) was calculated as the ratio of systolic AAA sac pressure to the simultaneously measured systolic aortic pressure, and was measured with and without proximal neck aortic balloon occlusion. The aneurysm sac was embolized with NLE during proximal neck aortic balloon occlusion immediately after EVAR. Endoleak and AAA sac diameter were evaluated by enhanced computed tomography and subtraction magnetic resonance imaging at 6 months and yearly after EVAR.

Results

Mean SPIs after EVAR with and without proximal neck aortic balloon occlusion were 0.36 and 0.57, respectively. There were no adverse events related to intraoperative sac embolization. Follow-up imaging (mean, 12.1 mo) revealed three minor endoleaks (12.5%) and no aneurysm sac expansion.

Conclusions

Prophylactic intraoperative sac embolization with NLE during proximal neck aortic balloon occlusion was safe and feasible and may reduce endoleaks and prevent sac expansion after EVAR in patients with unfavorable anatomic factors.