Predicting Success of Transarterial Embolization of Type II Endoleaks using Computed Tomography Angiography.

PURPOSE To evaluate the utility of preprocedural computed tomography angiography (CTA) in predicting technical success of transarterial embolization (TAE) of Type 2 endoleaks (T2EL), and in potentially guiding the treatment decision between TAE vs translumbar embolization. MATERIALS AND METHODS Fifty-eight patients (mean age, 74.4 years; age range, 46-89 years) who underwent attempted TAE for T2EL at our institution from July 2014 to August 2019 and who had pre-procedure CTAs were included in this retrospective study. Each CTA was evaluated for a feeding artery that was traceable over its entire course from either the SMA or the internal iliac artery to the endoleak cavity. TAE was performed using fibered coils and was considered technically successful if embolization of both the endoleak cavity and the feeding artery was performed. Rates of technical success were compared between patients with and without traceable feeding arteries. Statistical analysis was performed using Fisher's exact tests, two-sample t-tests and Chi-squared tests RESULTS: A fully traceable feeding artery was identified supplying 75% (44/59) of endoleaks in the cohort. TAE was a technical success in 95% (42/44) of these cases but only 13% (2/15) of cases without a fully traceable feeding artery (p < 0.001). When the IMA was the feeding artery, it was always fully traceable and TAE was a technical success in 33/33 cases (100%). When a lumbar artery served as the feeding artery, it was fully traceable in only 11/26 cases (42%). When the lumbar artery was not fully traceable, TAE was a technical success in only 2/15 cases (13%). CONCLUSION The traceability of a feeding artery over its entire course to an endoleak cavity on CTA was associated with technical success of TAE. Lumbar feeding arteries were less likely to be fully traceable and were associated with a higher rate of unsuccessful TAE. The high failure rate of TAE when the feeding artery was not fully traceable suggests that translumbar embolization could be considered as an initial approach for these patients with T2ELs.