Laparoscopic ligation of inferior mesenteric artery (IMA) for the management of type II endoleak post endovascular aneurysm repair (EVAR) (2020)

Type of publication:
Conference abstract

*Mashar R.; *Gangwar A.; *McCloud J.; *Shawish E.

British Journal of Surgery; 2020; vol. 107 ; p. 96-97

Aim: Type II endoleaks following EVAR are caused by patent aortic collaterals causing retrograde blood flow, with the IMA being involved in 45-85% of all cases. Transarterial embolization has been described as a management option, but with a high failure rate. We present laparoscopic ligation as an alternative therapeutic strategy, with both technical success and a favourable outcome.
Method(s): An 80-old hypertensive male was diagnosed with a type II endoleak post-EVAR. Shrinkage of the sac was seen initially from 58mm to 52mm on surveillance-computed tomography (CT) of the aorta at 6 months with apersistent type II endoleak involving the IMA and lumbar arteries. Surveillance at 18 months demonstrated a persistent endoleak with enlargement of the sac to 65 mm. After a failed attempt with arterial embolization, he underwent laparoscopic ligation of the IMA Results: The procedure time was 22 minutes and his length of stay was 2 days, with no signs or symptoms of bowel ischaemia. A CT at 2 weeks demonstrated sac shrinkage to 58 mm. Conclusion(s): There have been reports of persistent endoleaks being associated with adverse outcomes, with their primary management remaining controversial. IMA ligation has been associated with sac shrinkage in 65% of patients, an important prognostic factor, and there have been no reported complications thus far. Therefore, it should be strongly considered as an option for management of type II endoleaks in centres with both vascular and general surgical expertise being available

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