Ligation of Lumbar Arteries and Stent Graft-Conserving Aneurysmorrhaphy for Type II Endoleak

Koji Sato＊	Yasushige Shingu＊	Satoru Wakasa＊
Nobuyasu Kato＊	Tatsuya Seki＊	Tomonori Ooka＊
Hiroki Kato＊	Tsuyoshi Tachibana＊	Suguru Kubota＊
Yoshiro Matsui＊

（Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine＊, Sapporo, Japan）

Background:Persistent endoleak is a major cause of aneurysmal enlargement or rupture after endovascular aneurysm repair（EVAR). Although several reports have described ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy as useful strategies, treatment for type II endoleak after EVAR is controversial. Objectives:We investigated the early results in 5 patients who underwent ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy for type II endoleak. Methods:A＞10mm increase in aneurysm diameter after primary EVAR or a maximum diameter＞65mm serve as indications for intervention for type II endoleak. Under general anesthesia, following transperitoneal exposure of the abdominal aorta, the infrarenal aorta was banded using a tape at the proximal landing zone. After the aorta was opened without clamping, the lumbar arteries were ligated, and a stent graft-conserving aneurysmorrhaphy was performed. Results:The mean interval from the primary EVAR was 47±17 months. The mean operation time was 215±76 min. Blood transfusion was necessary in 4 patients（estimated blood loss 1,260±710ml). No in-hospital deaths were observed, and the mean postoperative hospital stay was 26±20 days. One patient developed aspiration pneumonia and 1 developed surgical site infection post-surgery. The diameter of the aneurysm changed from 68±8 to 47±5mm during hospitalization and decreased further to 36±7mm at the last follow-up. Conclusions:The early results of ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy were favorable. Although this strategy could be useful for aneurysmal dilatation secondary to persistent type II endoleak after EVAR, the indications for this approach should be determined following careful evaluation of the patient’s status considering the invasiveness of the procedure.

 

Jpn. J. Cardiovasc. Surg. 47:257-262（2018）

Keywords：abdominal aortic aneurysm;aneurysmorrhaphy;Type II endoleak