Clinical Study of the Results of Sac Prefilling Performed to Prevent Type II Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair.

Objectives: This study investigated the effectiveness and safety of sac prefilling (SP) with fibrin glue and/or a coil to prevent type II endoleaks (T2ELs) after endovascular aneurysm repair. The main outcome measure was prevalence of incidence of T2ELs.

Methods: First, this is a retrospective observational study on patients treated in our institution. Patients who underwent endovascular aneurysm repair between January 2017 and July 2022 were included and divided into the endovascular aneurysm repair and endovascular aneurysm repair with SP groups. Additionally, all patients were divided into high-risk (HR) and low-risk (LR) groups based on their risk for T2ELs. The prevalence of incidence of T2ELs at 1 year postoperatively was the main effectiveness index, and the colorectal ischemia complication rate was the main safety index.

Results: A total of 431 patients were included in this clinical study. The endovascular aneurysm repair group and SP group comprised 383 patients and 48 patients, respectively. No statistically significant differences between these groups were observed. The HR group included 282 patients; 246 of these patients were in the HR endovascular aneurysm repair group, and 36 were in the HR SP group. The prevalence of incidence of T2ELs in the endovascular aneurysm repair group was higher than that of the SP group at 6 and 12 months postoperatively (15.4% vs 2.8% and 13.2% vs 0%); statistically significant differences between these groups were observed (p = 0.039 and p = 0.032). The postoperative follow-up period was 60 months. A Kaplan-Meier curve analysis indicated that the cumulative T2EL incidence rate of the endovascular aneurysm repair group was significantly higher than that of the SP group (p = 0.011). The LR group included a total of 149 patients; 137 of these patients were in the endovascular aneurysm repair group, and 12 were in the SP group. No statistically significant differences between these groups were observed.

Conclusions: For patients with an abdominal aortic aneurysm who are at HR for T2ELs, SP could effectively, and safely prevent postoperative T2ELs.Clinical ImpactThis study points out that in patients with AAA, the sac prefilling technique is more suitable for patients with high-risk factors, so the operator should evaluate the patient's anatomical condition more thoroughly before EVAR.