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Master Thesis

L’embolisation préalable de l’artère mésentérique inférieure prévient l’augmentation du diamètre aortique après traitement par endoprothèse des anévrysmes de l’aorte abdominale

Abstract : Introduction: Endoleaks are the most frequently encountered complications after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA), and in particular type II endoleaks. Some studies have demonstrated the value of preventive embolization of the inferior mesenteric artery (IMA), but controversy persists as to its effectiveness and profitability. The aim of this retrospective study was to evaluate the efficiency of this practice in the prevention of aneurysmal sac’s expansion during follow-up. Material and method: All patients treated with EVAR between November 2007 and June 2016 were included. We then excluded symptomatic aneurysms, branched endoprostheses and patients with occluded, stenotic or <3 mm diameter AMI. The remaining population was divided into 2 groups: a group that had an embolization of the AMI before EVAR and a non-embolized (control) group. We then analyzed the diameter evolution of the aneurysmal sac, the rate of endoleaks and reoperation, and the cost of the two groups. Results: 224 patients were included. After exclusion we selected a group of 37 embolized patients and a control group of 46 patients. The technical success of embolization was 100% and we observed no complications. The incidence of increased diameter of the aneurysmal sac was significantly higher in the control group at 2 years (27.9% vs 4.3%, p = 0.025). The type II endoleak rate at 1 year was significantly higher in the control group (65% vs 15.2%, p <0.001) as well as the rate of reoperation related to the aneurysm (31.1% vs 8.1%, p = 0.013). Multivariate analysis confirmed the results obtained for diameter increase and type II endoleak. At 3 years of follow-up, the cost of the total care per patient was 13016 euros in the embolized group and 13135 euros in the control group. Conclusion: Preventive embolization of AMI is an effective, reliable and cost-effective technique that reduces the rate of increase in diameter of the aneurysmal bag, type II endoleak and re-intervention after EVAR.
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https://dumas.ccsd.cnrs.fr/dumas-01891371
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Submitted on : Tuesday, October 9, 2018 - 2:59:07 PM
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Michaël Vaillant. L’embolisation préalable de l’artère mésentérique inférieure prévient l’augmentation du diamètre aortique après traitement par endoprothèse des anévrysmes de l’aorte abdominale. Sciences du Vivant [q-bio]. 2017. ⟨dumas-01891371⟩

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