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One-year Outcomes Of Preemptive Aneurysm Sac Embolization For Infrarenal Endovascular Aneurysm Repair
Thomas F.X. O'Donnell, MD
1,
Alexandra A. Sansosti, MD1, Edvard Skripochnik, MD
2, Danielle R. Bajakian, MD
1, Nichloas J. Morrissey, MD
1, Lydia Miller, MD
1, Hiroo Takayama, MD, PhD
1, Virendra I. Patel, MD, MPH
1.
1Columbia University Irving Medical Center / NYP Hospital, New York, NY, USA,
2NYP Westchester, Bronxville, NY, USA.
Objectives: Aneurysm sac behavior has been associated with long-term survival and reinterventions, spurring an interest in more active management of the aneurysm sac during endovascular repair. We therefore investigated the utility of sac embolization with shape memory polymer plugs (SMP), (Shape Memory Medical, Santa Clara, CA), a novel, biodegradable, non-artifact-producing implant.
Methods: We retrospectively studied all patients undergoing endovascular repair of infrarenal aneurysms at two centers from 2/2022-1/2024 where SMPs were used. Safety outcomes included inadvertent embolization and sac perforation during manipulation. Efficacy outcomes were volume and diameter changes, as well as endoleaks, and reinterventions.
Results: There were 29 patients who underwent EVAR with SMP during the study period, with 22 having one year imaging for review. Mean age was 77 years (SD = 8.8 years) and 72% were men. Preoperative median total aneurysm volume was 98cc [IQR = 80-157cc], and median preoperative blood lumen volume was 70cc [IQR= 58-96.7cc], with 62% patent IMA and 1 accessory renal artery. The median number of plugs used per patient was 90 [IQR = 51-130]. The most frequently used grafts were the Gore Excluder (N= 23) and Cook Zenith (N= 6), with 4 iliac branch devices, 5 hypogastric coil covers, and Aptus Endoanchors in one patient. At one year, there were no patients with evidence of endoleak, no reinterventions, no adverse safety events during the procedure, and no perioperative deaths. The median percentage change in aneurysm volume at one year was 17% regression [IQR = 7-33%], and median change in aneurysm diameter was 6mm regression [IQR= -10mm - -1mm]. By diameter at one year postoperatively, 55% of patients demonstrated regression, 45% of patients demonstrated
stability, and there were no patients with expansion. In volume analysis, 67% showed >10% regression in aneurysm volume.
Conclusion: Preemptive aneurysm sac embolization at the time of EVAR is a safe, effective method of inducing sac thrombosis. At one year follow-up, patients have demonstrated high rates of sac regression, no endoleaks, and no need for reintervention. The SMPs hold promise over other coil or liquid embolic methods as they are biodegradable, and do not produce significant artifact on CT scan. Longer term data are needed to confirm these outcomes; however, one-year postoperative outcomes continue to demonstrate promise.
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