Relationship between preoperative patency of the inferior mesenteric artery and subsequent occurrence of type II endoleak in patients undergoing endovascular repair of abdominal aortic aneurysms

Objectives: The purpose of this study was (1) to find out whether preoperat ive inferior mesenteric artery (IMA) patency (on radiographic imaging) pred icts IMA-related endoleaks after endovascular repair of infrarenal abdomina l aortic aneurysms, (2) to determine feasibility of measuring aneurysm sac pressures in patients with endoleaks, and (3) to report early evidence of e ffective endovascular obliteration of IMA endoleaks. Methods: We studied 76 consecutive cases of infrarenal aortic aneurysms tha t were repaired with an endovascular approach (March 1998-April 1999). Results: There were 13 (17%) endoleaks persistent 30 days after the procedu re. Eleven (85%) of these 13 were IMA-related endoleaks, which were documen ted with selective superior mesenteric artery angiography. The preoperative finding (on computed tomogaphic scan) of a patent IMA. does not always pre dict an IMA-related endoleak, but results in a statistically and clinically significant higher ratio of patients with IMA-related endoleaks in the imm ediate postoperative period (24% versus 3%, P < .035). In eight of the 11 p atients with persistent IMA-related endoleaks, measurement of intra-aneurys m sac pressures was possible, and six of these patients had systemic pressu res within the excluded aneurysm sac. Nine (82%) of 11 IMA-related endoleak s were successfully obliterated by means of selective IMA embolization. Conclusions Many endoleaks are caused by a patent IMA, and this can result in persistence of systemic pressure within the aneurysm sac. The preoperati ve finding (on computed tomographic scan) of a patent IMA is a predictor of increased rates of IMA endoleaks, and IMA endoleaks can be successfully ob literated through endovascular procedures, after endovascular abdominal aor tic aneurysm repair.