Endovascular AAA repair: Prevention of side branch endoleaks with thrombogenic sponge

Purpose:To report a technique that might decrease the incidence of lumbar a rtery endoleaks following endovascular repair (EVR) of abdominal aortic ane urysms (AAAs). Methods: Ninety-three patients (86 males, median age 72 years, range 56 to 88) undergoing EVR with the aortomonoiliac technique were entered into a st udy to detect and then occlude patent side branches before completion of th e endografting procedure. Prior to deploying the iliac occluder, an aneurys mogram was performed to detect patent aortic side branches. If these side b ranches were found, an absorbable gelatin sponge was inserted into the aneu rysm sac via the occluder introducer sheath. The patients were followed wit h contrast-enhanced spiral computed tomography (CT) at 1 week and 3, 6, and 12 months to detect the presence of endoleaks. Results: Forty-eight (52%) patients demonstrated patent side branches that were occluded by the insertion of gelatin sponges into the aneurysm sac. Th e remaining 45 patients without evidence of side branch flow were untreated . Ten (10.7%) patients died in the perioperative period, and 15 (16.1%) pri mary endoleaks (13 proximal, 2 distal) were detected. This left 68 (73.1%) patients for follow-up, 33 (48.5%) of whom had patent branch vessels treate d with the thrombogenic sponge. The median follow-up was 4 months (range 1 to 17), during which time no side branch endoleak was detected on surveilla nce CT scans in any of the 68 patients, which included all patients treated with the thrombogenic sponge technique and those in whom no patent side br anches had been identified. Conclusions: We have demonstrated a safe and reliable method of preventing lumbar artery endoleaks following endovascular AAA repair.