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3 . 2026

Preoperative mapping and selective embolization of aneurysm sac side branches before endovascular repair of abdominal aortic aneurysm

Abstract

Background. Endovascular aneurysm repair (EVAR) has firmly established itself as the standard treatment for an infrarenal abdominal aortic aneurysm; however, type II endoleak and the associated aneurysm sac enlargement remain one of the leading causes of reinterventions. In this context, the development of reproducible protocols for preoperative planning of selective embolization of aneurysm sac side branches is of particular interest.

Objective. To assess the technical feasibility and early outcomes of applying a standardized protocol for preoperative mapping and selective embolization of aneurysm sac side branches in patients with infrarenal abdominal aortic aneurysm undergoing endovascular repair.

Patients and methods. The study included 36 patients with an infrarenal abdominal aortic aneurysm who underwent preoperative selective embolization of aneurysm sac side branches between 2023 and 2025. Preoperative planning was based on multidetector CT aortography with quantitative assessment of the number of side branches, skeletal topographic localization of their origins, and predefined selection of endovascular equipment. Follow-up CT aortography was performed at 12 months.

Results. In 10 (27.8%) patients, only the inferior mesenteric artery was embolized, in 12 (33.3%) only lumbar arteries, and in 14 (38.9%) both vascular territories. At 12‑month follow‑up, type II endoleak was detected in 4 (11.1%) patients, whereas clinically significant aneurysm sac enlargement was observed in 2 (5.6%) patients and required repeat embolization.

Conclusions. A standardized protocol for CT-based preoperative mapping of aneurysm sac side branches with subsequent selective embolization of lumbar arteries and the inferior mesenteric artery is technically feasible and reproducible in patients with an infrarenal abdominal aortic aneurysm. This approach is associated with an acceptable rate of type II endoleaks and a low incidence of clinically significant aneurysm sac enlargement and may be considered a promising component of type II endoleak prevention strategies

Keywords:abdominal aortic aneurysm; endovascular aneurysm repair; type II endoleak; inferior mesenteric artery embolization; lumbar artery embolization

Authors’ contribution. Study conception and design, data collection and handling, draft manuscript preparation, manuscript revision – Polyakov R.S., Kur-ipa K.A., Chargazia Sh.G., Puretskiy M.V., Saakyan Yu.M., Mardanyan G.V., Pirkova A.A., Karuk M.V., Saurin K.R., Abugov S.A.

For citation: Polyakov R.S., Kur-ipa K.A., Chargazia Sh.G., Puretskiy M.V., Saakyan Yu.M., Mardanyan G.V., Pirkova A.A., Karuk M.V., Saurin K.R., Abugov S.A. Preoperative mapping and selective embolization of aneurysm sac side branches before endovascular repair of abdominal aortic aneurysm. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 50–5. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-50-55

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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