Pre-emptive embolization of inferior mesenteric and lumbar arteries in endovascular abdominal aortic aneurysm repair

Polyakov R.S.; Kur-ipa K.A.; Chargaziya Sh.G.; Puretskiy M.V.; Saakyan Yu.M.; Mardanyan G.V.; Pirkova A.A.; Safonova V.M.; Karuk M.V.; Abugov S.A.

doi:https://doi.org/10.17116/hirurgia20251125

Polyakov R.S.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-9323-4003

Kur-ipa K.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-2395-5999

Chargaziya Sh.G.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-8598-2933

Puretskiy M.V.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0003-4988-4102

Saakyan Yu.M.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-4497-1832

Mardanyan G.V.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-7442-520X

Pirkova A.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-5101-1004

Safonova V.M.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0003-4631-2408

Karuk M.V.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-2292-6758

Abugov S.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0001-7636-4044

Pre-emptive embolization of inferior mesenteric and lumbar arteries in endovascular abdominal aortic aneurysm repair

Authors:

Polyakov R.S., Kur-ipa K.A., Chargaziya Sh.G., Puretskiy M.V., Saakyan Yu.M., Mardanyan G.V., Pirkova A.A., Safonova V.M., Karuk M.V., Abugov S.A.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2025;(11‑2): 5‑11

DOI: 10.17116/hirurgia20251125

Read: 409 times

Contact the author

Table of contents

To cite this article:

Polyakov RS, Kur-ipa KA, Chargaziya ShG, et al. Pre-emptive embolization of inferior mesenteric and lumbar arteries in endovascular abdominal aortic aneurysm repair. Pirogov Russian Journal of Surgery. 2025;(11‑2):5‑11. (In Russ.)
https://doi.org/10.17116/hirurgia20251125

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

OBJECTIVE

To evaluate the impact of pre-emptive embolization of inferior mesenteric and lumbar arteries on the incidence of type II endoleak and aneurysm sac dimensions after EVAR.

MATERIAL AND METHODS

A retrospective single-center cohort study included 145 patients who underwent EVAR between 2023 and 2025. Patients were divided into two groups: with pre-emptive embolization (n=32) and without this procedure (n=113). Follow-up CT angiography was performed after 12 months. Primary endpoint was the incidence of type II endoleak; secondary endpoints included changes in maximal aneurysm diameter and infrarenal aortic volume.

RESULTS

After 12 months, type II endoleak was observed in 3.1% and 17.7% of cases, respectively (p=0.045). Aneurysm sac growth occurred in 6.3% and 15.9% of patients, respectively (p=0.246). Embolization procedures were associated with longer surgery time, increased fluoroscopy duration and greater contrast volume.

CONCLUSION

Pre-emptive embolization of inferior mesenteric and lumbar arteries in EVAR reduces the incidence of type II endoleak and shows a trend towards less aneurysm sac growth despite higher technical complexity and contrast volume.

Keywords:

abdominal aortic aneurysm

endovascular aortic repair

type II endoleak

embolization

inferior mesenteric artery

lumbar arteries

Authors:

Polyakov R.S.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-9323-4003

Kur-ipa K.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-2395-5999

Chargaziya Sh.G.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-8598-2933

Puretskiy M.V.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0003-4988-4102

Saakyan Yu.M.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-4497-1832

Mardanyan G.V.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-7442-520X

Pirkova A.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-5101-1004

Safonova V.M.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0003-4631-2408

Karuk M.V.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-2292-6758

Abugov S.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0001-7636-4044

Received:

10.07.2025

Accepted:

12.08.2025

Close metadata

References:

Monzio-Compagnoni N, Zuccon G, Barbosa F, Rampoldi AG, Tolva VS. Incidence and Long-Term Implications of Type 2 Endoleak after Endovascular Repair of Abdominal Aortic and Aortoiliac Aneurysms. International Journal of Angiology. 2023;33(4):282-287. https://doi.org/10.1055/s-0043-1771344
Hatzl J, Wang V, Hakimi M, Uhl C, Rengier F, Bruckner T, Böckler D. Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated with AAA Expansion. Journal of Endovascular Therapy. 2023;30(3):372-381. https://doi.org/10.1177/15266028221081079
Kim H, Hwang D, Huh S, Yun WS, Kim HK. Effects of Pre-emptive Aortic Side Branch Embolization on Early-Stage Type II Endoleaks and Sac Changes After Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm. Vascular Specialist International. 2025;41:10. https://doi.org/10.5758/vsi.250010
Kondov S, Dimov A, Beyersdorf F, Maruschke L, Pooth JS, Kreibich M, Kaier K, Siepe M, Czerny M, Rylski B. Inferior mesenteric artery diameter and number of patent lumbar arteries as factors associated with significant type 2 endoleak after infrarenal endovascular aneurysm repair. Interdisciplinary CardioVascular and Thoracic Surgery. 2022;35(1):ivac016. https://doi.org/10.1093/icvts/ivac016
Zettervall SL, Schanzer A. ESVS 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms: A North American Perspective. European Journal of Vascular and Endovascular Surgery. 2024;67(2):187-189. https://doi.org/10.1016/j.ejvs.2023.10.036
Nakai H, Iwakoshi S, Takimoto S, Taniguchi T. Preemptive Embolization of the Lumbar Arteries and Inferior Mesenteric Artery to Prevent Abdominal Aortic Aneurysm Enlargement Associated with Type 2 Endoleak Following Endovascular Aneurysm Repair. Interventional radiology (Higashimatsuyama-shi Japan). 2023;8(3):146-153. https://doi.org/10.22575/interventionalradiology.2023-0007
Suárez González LÁ, Martínez-Luengas IL, Del Canto Peruyera P, Vallina-Victorero Vazquez MJ. Safety of preoperative branch embolization in patients undergoing evar. Jornal Vascular Brasileiro. 2024;23:e20220137. https://doi.org/10.1590/1677-5449.202201372
Ichihashi S, Takahara M, Fujimura N, Nagatomi S, Iwakoshi S, Bolstad F, Kichikawa K. Multicentre randomised controlled trial to evaluate the efficacy of pre-emptive inferior mesenteric artery embolisation during endovascular aortic aneurysm repair on aneurysm sac change: protocol of Clarify IMA study. BMJ Open. 2020;10(2):e031758. https://doi.org/10.1136/bmjopen-2019-031758
Wu Y, Yin J, Hongpeng Z, Wei G. Systematic review and network meta-analysis of pre-emptive embolization of the aneurysm sac side branches and aneurysm sac coil embolization to improve the outcomes of endovascular aneurysm repair. Frontiers in Cardiovascular Medicine. 2022;9:947809. https://doi.org/10.3389/fcvm.2022.947809
de Ruiter QMB, Moll FL, Hazenberg CEVB, van Herwaarden JA. Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room: An Instant Operator Risk Chart for Daily Practice. Journal of Endovascular Therapy. 2021;28(4):530-541. https://doi.org/10.1177/15266028211007458
Arnautovic A, Garabet W, Ziegler RT, Mulorz J, Braß SM, Oberhuber A, Schelzig H, Wagenhäuser MU, Dueppers P. Radiation Exposure and Contrast Agent Use during Endovascular Aortic Repair Using Mobile Versus Fixed Angiography Systems. Journal of Cardiovascular Development and Disease. 2024;11(3):83. https://doi.org/10.3390/jcdd11030083
Polyakov RS, Chargaziya ShG, Kur-ipa KA, Puretskiy MV, Mardanyan GV, Pirkova AA, Khovrin VV, Malakhova MV, Abugov SA. Optimal assessment of abdominal aortic aneurysm models morphology by computed tomography. Russian Journal of Endovascular Surgery. 2022;9(4):369-374. (In Russ.). https://doi.org/10.24183/2409-4080-2022-9-4-369-374
Polyakov RS, Kur-ipa KA, Chargaziya ShG, Puretskiy MV, Saakyan YuM, Mardanyan GV, Pirkova AA, Safonova VM, Karuk MV. Analysis of changes in the volume and diameter of the infrarenal aortic segment in patients after endovascular abdominal aortic repair. Russian Journal of Endovascular Surgery. 2024;11(4):445-451. (In Russ.).
Bellosta R, D’Amario F, Luzzani L, Pegorer MA, Pucci A, Casali F, Bashir M, Attisani L. Outcome Analysis of Pre-Emptive Embolization of the Collateral Branches of the Abdominal Aorta During Standard Infrarenal Endovascular Aortic Repair. Journal of Clinical Medicine. 2025;14(7):2391. https://doi.org/10.3390/jcm14072391
Korchazhkina NB, Mikhailova AA, Reshetova IV, Dimova OV, Kotenko KV. Modern approaches to developing a system of valid methods for monitoring individual health and maintaining active longevity. Problems of Balneology, Physiotherapy and Exercise Therapy. 2023;100(6):6-13. (In Russ.). https://doi.org/10.17116/kurort20231000616
Korchazhkina NB, Mikhailova AA, Badimova AV, Reshetova IV, Dymova OV, Eremin II, Kotenko KV. Methods and markers of prenosological diagnosis and monitoring of individual health and maintenance of active longevity. Problems of Balneology, Physiotherapy and Exercise Therapy. 2023;100(5-2):20-21. (In Russ.).