Selective aneurysmal sac neck-targeted embolization during endovascular aneurysm repair of abdominal aortic aneurysm with hostile neck anatomy

Purpose: To evaluate the efficacy and safety of selective aneurysmal sac neck-targeted embolization in patients undergoing endovascular aneurysm repair (EVAR) with hostile neck anatomy. Materials: and Methods: We enrolled 28 patients with hostile neck anatomy who underwent EVAR with a low-profile stent graft between October 2020 and June 2022. Before excluding the entire aneurysm during the procedure, a buddy wire was loaded prophylactically into the sac through the contralateral limb side. When type Ia endoleak persist despite adjunctive treatment, this preloaded wire could be utilized as an access to enable a catheter to reach the space between the stent graft and sac neck to perform coil embolization. In the absence of type Ia endoleak, the wire was simply retracted. The primary outcome of this study was freedom from sac expansion and endoleak-related reinterventions during the follow-up period; secondary outcomes included technical success, intraoperative and in-hospital postoperative complications. Results: : Out of the 28 patients with hostile neck morphology, 11 of them (39.5%) who had type Ia endoleak received intra-procedure treatment with sac neck-targeted detachable coil embolization. The preloaded wire was removed from 17 patients (60.7%) who did not show type Ia endoleak. The coiling group had longer operating durations (81.27±11.61 vs. 70.71±7.17 minutes, P<0.01) and utilized more contrast than the non-coiling group (177.45±52.41 vs. 108.24±17.49 ml, p<0.01). In the entire cohort, technical success was 100% and there were no procedure-related complications. At a mean follow-up of 18.6±5.2 months (range 12-31), there was no sac expansion(19 sac regression, 67.86%; 9 stability, 32.14% ) and endoleak-related reintervention. Conclusions: : Selective aneurysmal sac neck-targeted embolization for the treatment of type Ia endoleak in patients with hostile neck anatomy undergoing EVAR is safe and could reduce type Ia endoleak and prevent related sac expansion after EVAR.