Active sac management for prevention of type II endoleaks after endovascular aneurysm repair
Abstract
Background: Type II endoleaks (T2EL) remain the most common complication after endovascular aneurysm repair (EVAR). Aneurysm sac regression is a predictor for better treatment outcomes compared to sac stability and growth. T2EL are associated with aneurysm sac regression and prophylactic embolization of the sac or side branches may result in lower T2EL incidence. This review aims to assess the current evidence on whether prophylactic treatment strategies provide improved clinical outcomes after EVAR. Materials and methods: A systematic search was performed of the Scopus, PubMed and Web of Science databases. Original studies reporting prophylactic embolization to prevent endoleaks were included and a meta-analysis was performed on important clinical outcome parameters; T2EL incidence, sac remodelling and T2EL related reinterventions. Results: A total of 1,870 publications were identified. After screening and quality assessment by two reviewers, data were extracted from 29 studies and analysed. T2EL incidence was significantly lower in the embolization group; odds ratio 0.29 [0.19-0.45, 95% confidence interval] at 6 months, 0.20 [0.13-0.31] at 12 months and 0.28 [0.14-0.55] at 24 months. Sac growth was significantly lower in the embolization group with odds ratios of 0.08 [0.01-0.59], 0.16 [0.05-0.53] and 0.24 [0.11-0.52] at 6, 12 and 24 months, respectively. Sac shrinkage was significantly higher in the embolization group with odds ratios of 0.42 [0.28-0.63], 0.49 [0.32-0.77]…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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