Outcome Analysis of Preemptive Embolization of Collateral Branches of the Abdominal Aorta During Standard Infrarenal Endovascular Aortic Repair

Objectives. To report the results of the preemptive embolization of the collateral branches of the abdominal aorta in patients undergoing standard bifurcated EVAR. Methods. It is a single-center, retrospective, observational cohort study of consecutive patients treated electively with standard EVAR between October 1st, 2013, and December 31st, 2022, and with a follow-up of 2-years at least. We divided the patients in two groups: no embolization (group A) and preemptive embolization of aortic collateral branches (group B). Primary outcomes were overall survival, freedom from aorta-related mortality (ARM), and freedom from T2E-related reintervention. The secondary outcome was the assessment of freedom from an aneurysm sac increase. Results. We analyzed 265 EVARs: 183 (69.1%) in group A, and 82 (30.9%) in group B. The median follow-up was 48 months [interquartile (IQR), 28-65.5], and it was not different between the two groups (P = 0.098). Estimated cumulative survival was 87% (0.2) at 2 years (95%CI: 82.6-92.9) and 67% (0.3) at 5 years (95%CI: 60.3-73.1) with no difference between the groups (P = 0.263). Aorta-related mortality rate was 1.1% (n = 3), following open conversion for endograft infection (n = 2), and secondary aortic rupture (n = 1). The freedom from T2E-related reintervention was 99% (0.01) at 2 years (95%CI: 99.4-99.8) and 88% (0.3) at 5 years (95%CI: 81.4-92.5): there was no difference between the groups (P = 0.282). Cox’s regression analysis identified age > 80 years as an independent negative predictor for survival (HR: 3.5, 95%CI: 2.27-5.50, P < 0.001), and T2E-related reintervention (HR: 2.4, 95%CI: 1.05-5.54, P = 0.037). Conclusions. Preemptive embolization of the aortic collateral branches does not confer better aor-ta-related outcomes after EVAR.