Radiation Exposure from Preemptive Coil Embolization vs. Secondary Interventions for Endoleak-Induced Aneurysm Sac Growth following Endovascular Abdominal Aortic Aneurysm Repair.

Abstract

Objective: Preemptive embolization of the inferior mesenteric artery (IMA) and lumbar arteries (LA) has been shown to reduce aneurysm sac growth and secondary interventions following endovascular aneurysm repair (EVAR). It is unclear if this strategy will increase radiation exposure compared to secondary interventions performed for endoleak-induced sac growth. We examined the cumulative procedural radiation exposure associated with preemptive embolization of aneurysm sac branches and compared it to that of secondary interventions.

Methods: A retrospective analysis was performed on patients who underwent EVAR for non-ruptured, infrarenal abdominal aortic aneurysms (AAA) from January 2012 to December 2022, followed-up until February 2024. Procedural radiation data was collected using fluoroscopy time (mins), dose area product (DAP, μGym²), and radiation dose (mGy). Cumulative radiation exposure included preemptive embolization, EVAR, and any endovascular secondary interventions for sac growth.

Results: There were 112 patients (90 male, mean age 72.4±8.3 yrs., mean AAA diameter 58.4±12.3 mm) with available radiation data. Preemptive embolization was associated with significantly fewer secondary interventions (8/55 [14.5%] preemptive embolization only vs. 20/57 [35%] no preemptive embolization, needed secondary intervention, p=0.012). Patients were grouped as follows: Group 0 (G0) no preemptive embolization or secondary intervention (n=37), Group 1 (G1) preemptive embolization only (n=47), Group 2 (G2) secondary intervention only (n=20), Group 3 (G3) both preemptive embolization and secondary intervention (n=8). Fluoroscopy time, total DAP, and radiation dose from EVAR did not differ significantly among the four groups. Radiation exposure was significantly higher in those with secondary intervention only (G2: DAP 110,567 μGym² ±132,296) compared to those who were preemptively embolized and still needed a secondary intervention (G3: DAP 71,566 μGym² ±49,592, p=0.0016). This is because patients with secondary interventions only required more sessions of endovascular procedures compared to those who received preemptive embolization and still required secondary interventions (G2: 2.2 vs G3: 1.23 sessions, p<0.001). Total radiation exposure was significantly different across groups, with the highest in patients who received secondary interventions only (Group 2).

Conclusions: Preemptive embolization of aneurysm sac branches was associated with less secondary interventions for sac growth post-EVAR. Cumulative radiation exposure in patients who received preemptive embolization was significantly less compared to that in patients who underwent secondary interventions for endoleak-induced sac growth. Preemptive embolization may mitigate secondary interventions and reduce overall radiation exposure in patients with AAA being treated with EVAR.