Preemptive aortic side branch embolization during EVAR using the Excluder stent-graft system: A prospective multicenter study

Purpose The occurrence of endoleaks, particularly type 2 endoleaks (EL2), is the primary cause of poor long-term prognosis after endovascular aneurysm repair (EVAR). This study aimed to evaluate the efficacy and safety of preemptive transcatheter arterial embolization (P-TAE) for aortic side branches (ASBs) to prevent EL2 before EVAR using the Excluder stent-graft system (EXCLUDER). Materials and methods In this prospective, multicenter study, 80 patients (mean age, 79.1±6.7 years; 85.0% male patients; mean aneurysmal sac diameter, 48.4±7.4 mm) meeting the eligibility criteria were prospectively enrolled from nine hospitals. Before EVAR, p-TAE was performed to embolize the patent ASBs originating from the abdominal aortic aneurysm. Contrast-enhanced computed tomography was performed at 1 month and 6 months after EVAR. The primary endpoint was EL2 incidence at 6 months, and the secondary endpoints were aneurysmal sac diameter changes at 6 and 12 months, P-TAE outcomes, complications related to P-TAE, re-intervention, and aneurysm-related mortality. Results All patients successfully underwent P-TAE without serious complications. Coil embolization was successful in 81.6% of ASBs. EL2 incidence at 6 months was identified in 18/70 (25.7%) patients. Aneurysmal sac diameter shrinkage (≥5 mm) was observed in 30.0% of patients at 6 months and in 40.9% at 12 months. Only one patient required re-intervention for EL2 within 1 year of EVAR; aneurysm-related deaths were not observed. Conclusion P-TAE for ASBs before EVAR using EXCLUDER is a safe and effective strategy. It aids in achieving early aneurysmal sac shrinkage and reduces EL2 re-intervention at 1 year after EVAR.