Technical and clinical results of prophylactic coiling of infrarenal aortic side branches during endovascular aneurysm repair.

Abstract

To analyze technical and clinical results of prophylactic coiling procedures during endovascular aneurysm repair (EVAR) in a single center. This is a retrospective, single-center observational study of patients who underwent standard elective EVAR between 2019 and 2023. Patients who underwent prophylactic coil embolization of infrarenal aortic side branches were compared with a control group. The study endpoints were technical and clinical success, dose area product, fluoroscopy and intervention time, contrast volume, incidence of type II endoleaks (T2EL), freedom from aortic aneurysm expansion or shrinkage >5 mm and reinterventions of all causes. In total, 187 patients received an EVAR procedure with a mean follow-up (FU) of 308.1 ± 296.4 days. Almost one-third of them qualified for a coiling procedure (49 patients). Overall, coil embolization was technically successful in 63.3% of cases (31/49).Prophylactic coiling significantly increased the radiation exposure (10,304.3 ± 8253.2 μGym² vs 5844.8 ± 3774.5 μGym²; P = .001), intervention time (144.8 ± 42.7 minutes vs 120.7 ± 39.1 minutes; P = .001), and fluoroscopy time (35.8 ± 19.3 minutes vs 23.3 ± 13.7 minutes; P = .00). Considering clinical success, the rate of T2EL in the group with successful coiling was 51.6% (16/31) in the postoperative computed tomography angiography compared with a rate of 36.5% in the control group (57/156) (P = .21). The rate of aneurysm shrinkage in the overall FU was 20% in the coiling group (5/25) vs 40% in the control group (36/90) (P = .24). The rate of aneurysm enlargement was 13% in the coiling group (3/23) vs 6.6% in the control group (6/90) (P = .09). During FU, the number of reinterventions for all causes was 12.9% in the coiling group (4/31) and 12.2% in group 2 and 3 (19/156) (P = .9). In this study, prophylactic coil embolization to the extent in this cohort did not translate to a clinical benefit while leading to a significant increase in radiation exposure. Further research is therefore needed to identify high-risk patients for persistent T2EL, and to identify the extent of embolization needed to effectively reduce T2EL and its sequelae.