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Diagnosis and Treatment of Inferior Mesenteric Arterial Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms¹

¹ From the Section of Interventional Radiology, the Department of Radiology (R.A.B., C.M.T., M.C.S.); and the Department of Surgery (J.P.C., O.C.V., C.F.B., M.A.G., A.M.P., R.M.F.), University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. Received March 12, 1999; revision requested May 3; final revision received October 12; accepted November 23. Address correspondence to R.A.B. (e-mail: baumr@rad.upenn.edu).

PURPOSE: To review the incidence and repair of inferior mesenteric arterial (IMA) type II endoleaks after endovascular repair of abdominal aortic aneurysms.

MATERIALS AND METHODS: Fifty patients who underwent endovascular repair of abdominal aortic aneurysms were examined. If an endoleak was identified at 30-day postoperative computed tomography, conventional arteriography was performed to identify and eliminate its source. After the exclusion of attachment site leaks, a catheter was placed selectively in the superior mesenteric artery (SMA). If retrograde filling of the IMA and aneurysm was identified, coil embolization was attempted through the SMA and middle colic artery. Intrasac pressures were measured at embolization.

RESULTS: Eight of 50 patients (16%) had type II endoleaks that were attributed to retrograde flow in the IMA. Intrasac measurements demonstrated systemic pressure in six patients and one-half systemic pressure in two patients. The IMA was embolized through the SMA and left colic artery in seven patients and through the translumbar aorta in one patient.

CONCLUSION: Retrograde flow in the IMA is responsible for many type II endoleaks. Systemic pressures are transmitted into the aneurysm sac from the IMA. The IMA can be embolized successfully with an SMA approach in most patients.

Index terms: Aneurysm, abdominal, 981.732 • Aneurysm, aortic, 981.732 • Aneurysm, therapy, 981.1264, 981.1268 • Aortography, 981.1213 • Arteries, therapeutic embolization, 956.1264 • Stents and prostheses, 981.1268

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