Endovascular stent-graft in abdominal aortic aneurysms: The relationship between patent vessels that arise from the aneurysmal sac and early endoleak

PURPOSE: To determine the association of patent sac branch vessels (lumbar and inferior mesenteric arteries [IMAs]) with early endoleak rate after ste nt-graft repair of abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: Pre- and postoperative computed tomographic (CT) ang iograms in 158 patients who underwent stent-graft AAA repair were retrospec tively reviewed to determine the preoperative patency of IMAs and other sac branch vessels (feeders) and presence or absence of immediate postoperativ e endoleak. Relationships of early endoleak rate with total branch vessel, IMA, and lumbar artery patency and graft type were evaluated. RESULTS: There was a significant association between patency of sac feeders and rate of early endoleak, especially type 2. As total patent feeders inc reased from zero to three to four to six, total endoleak rate increased fro m 6% (one of 17) to 35% (30 of 86); type 2 endoleak rate, from 0% to 5%. IM A patency was significantly associated with total early endoleak rate. Incr easing lumbar artery patency also was associated with significantly higher total and type 2 endoleak rates: With zero to three lumbar arteries, the to tal endoleak rate was 17% and type 2. endoleak rate was 13%, as compared wi th 60% and 50%, respectively, with more than six patent lumbar arteries. CONCLUSION: Sac branch vessel patency is associated with significantly high er early total and type 2 endoleak rates after stent-graft repair of AAAs; thus, patent sac branches play an important role in the pathogenesis of end oleaks.