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Review
. 2022 Sep 19;11(18):5491.
doi: 10.3390/jcm11185491.

Effectiveness of Inferior Mesenteric Artery Embolization on Type II Endoleak-Related Complications after Endovascular Aortic Repair (EVAR): Systematic Review and Meta-Analysis

Natalia Niklas  1 , Michalina Malec  1 , Piotr Gutowski  1 , Arkadiusz Kazimierczak  1 , Paweł Rynio  1
Affiliations
Review

Effectiveness of Inferior Mesenteric Artery Embolization on Type II Endoleak-Related Complications after Endovascular Aortic Repair (EVAR): Systematic Review and Meta-Analysis

Natalia Niklas et al. J Clin Med. .

Abstract

Type II endoleak is one of the most common and problematic complications after endovascular aneurysm repair. It has been suggested that the inferior mesenteric artery (IMA) embolization could prevent further adverse events and postoperative complications. This article is a systematic review and meta-analysis following PRISMA guidelines. The Medline, PubMed, Embase, and Cochrane databases were used to identify studies that investigated the effect of IMA embolization on the occurrence of type II endoleaks and secondary interventions in a group of patients with abdominal aortic aneurysm who underwent EVAR compared with results after EVAR procedure without embolization. A random effects meta-analysis was performed. Of 3510 studies, 6 studies involving 659 patients were included. Meta-analysis of all studies showed that the rate of secondary interventions was smaller in patients with IMA embolization (OR, 0.17; SE, 0.45; 95% CI, 0.07 to 0.41; p < 0.01; I2 = 0%). The occurrence of type II endoleaks was also smaller in the embolization group (OR, 0.37; SE, 0.21; 95% CI, 0.25 to 0.57; p < 0.01; I2 = 16.20%). This meta-analysis suggests that IMA embolization correlates with lower rates of type II endoleaks and secondary interventions.

Keywords: embolization; inferior mesenteric artery; type II endoleak.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases only. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Association between IMA embolization and rate of secondary reinterventions. The horizontal line represents 95% confidence intervals (CIs). N, number of patients; OR, odds ratio; SE, standard error. Data referred from reference [22,23,24,25,26,27].
Figure 3
Figure 3
Association between IMA embolization and occurrence of endoleak type II. The horizontal line illustrates 95% confidence intervals (CIs). N, number of patients; OR, odds ratio; SE, standard error. Data referred from reference [22,23,24,25,26,27].
Figure 4
Figure 4
Leave-one-out meta-analysis for the occurrence of type II endoleak. Data referred from reference [22,23,24,25,26,27].
Figure 5
Figure 5
Leave-one-out meta-analysis with random effect and change of precision for the occurrence of type II endoleak. Data referred from reference [22,23,24,25,26,27].
Figure 6
Figure 6
Leave-one-out meta-analysis for the rate of secondary reinterventions. Data referred from reference [22,23,24,25,26,27].
Figure 7
Figure 7
Leave-one-out meta-analysis with random effect and change of precision for the rate of secondary reinterventions. Data referred from reference [22,23,24,25,26,27].
Figure 8
Figure 8
Funnel plot for the occurrence of type II endoleak.
Figure 9
Figure 9
Funnel plot for secondary reinterventions.
See this image and copyright information in PMC

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