| Objective:The efficacy of prophylactic aneurysm embolization is unclear.The purpose of this study is to evaluate the safety and efficacy of prophylactic sac embolization with N-butyl cyanoacrylate(NBCA)during endovascular aneurysm repair(EVAR)in patients suffering from abdominal aortic aneurysms(AAA)to prevent type II endoleaks.Method:A retrospective analysis was performed on AAA patients who underwent EVAR from January 2019 to January 2022.And a total of 74 patients were included according to strict inclusion and exclusion criteria,of whom 36 patients(experimental group)underwent prophylactic intraoperative sac injection of NBCA to embolize the sac during EVAR and 38 patients(control group)received standard EVAR treatment.The clinical data of the above 74 patients were collected,including age,gender,Body Mass Index(BMI),underlying diseases(hypertension,heart disease,diabetes,etc.),diameter and volume of aneurysm,hospitalization cost,preoperative laboratory indices(leukocytes,neutrophils,hemoglobin,lymphocytes,C-reactive protein,etc.),duration of surgery,type of stent,type of anesthesia,etc.The primary endpoint was the incidence of type II endoleaks during follow-up,and secondary endpoints included changes in diameter and volume,the incidence of other endoleaks,the rate of endoleak-related reinterventions,adverse events,and mortality during follow-up.Results:There were no statistically significant differences in gender,age,diameter[55.46(15.60)mm vs.63.15(24.00)mm],volume[183.05(139.63)cm~3vs.237.45(204.81)cm~3],and underlying disease between the experimental group and control group before surgery,there were no intraoperative complications,and the technical success rate was 100%in both groups.At 3 months postoperatively,the incidence of type II endoleaks in the experimental group was significantly lower than that in the control group(2.86%vs.21.05%,P<0.01);at 6 months,the incidence of type II endoleaks in the two groups was 8.82%vs.28.95%(P<0.01);at 12 months,the incidence of type II endoleaks in the two groups was 8.82%vs.31.43%(P<0.01).The diameter and volume at 3 months was 54.40(18.60)mm vs.61.75(24.83)mm(P=0.091)and 178.50(143.50)cm~3vs.237.50(196.85)cm~3(P=0.075)in the experimental and control groups,respectively;the diameter and volume in the experimental and control groups 51.60(17.00)mm vs.61.25(24.78)mm(P=0.033)and165.30(150.48)cm~3vs.237.20(186.93)cm~3(P=0.028)for the experimental group and control group respectively at 6 months;at 12 months,49.10(16.91)mm vs.59.30(19.80)mm(P=0.025)and 144.70(112.98)cm~3vs.223.80(160.00)cm~3(P=0.013)in the experimental and control groups,respectively.Four reinterventions were performed in the experimental group,one of which was associated with type II endoleaks,and eight reinterventions were performed in the control group,six of which were associated with type II endoleaks.The overall reintervention rate was not statistically different between the two groups(P=0.224),and the reintervention rate associated with type II endoleaks was slightly lower in the experimental group than in the control group,but there was no statistical difference(P=0.106).One patient in the experimental group developed spinal cord ischemia after surgery,which manifested as urinary incontinence and loss of motor function,and improved after 3 days of conservative treatment.Two patients died in the experimental and control groups,respectively,including one patient in the experimental group who underwent reintervention on the second day after surgery,and died on the third day after surgery,the difference was not statistically significant.Binary Logistic regression analysis was used to explore the influencing factors of typeⅡendoleak in this study,including sac embolization and neutrophil to lymphocyte ratio>2.99.Conclusions:Prophylactic injection of NBCA into the sac of AAA in EVAR is a simple,safe and effective method,which can significantly reduce the occurrence of type II endoleaks in the early and middle stages,prevent the enlargement of the sac after EVAR,and has no significant effect on the re-intervention rate and mortality,does not significantly prolong the operation time and the dose of contrast agent. |
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