Endovascular aortic repair with sac embolization for the prevention of type II endoleaks (the EVAR-SE study): study protocol for a randomized controlled multicentre study in Germany

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Christoph Knappich - , Technical University of Munich (Author)
  • Felix Kirchhoff - , Technical University of Munich (Author)
  • Marie Kristin Fritsche - , Technical University of Munich (Author)
  • Silvia Egert-Schwender - , Technical University of Munich (Author)
  • Heiko Wendorff - , Technical University of Munich (Author)
  • Michael Kallmayer - , Technical University of Munich (Author)
  • Bernhard Haller - , Technical University of Munich (Author)
  • Alexander Hyhlik-Duerr - , Augsburg University (Author)
  • Christian Reeps - , Department of Visceral, Thoracic and Vascular Surgery, University Medicine (Faculty of Medicine and University Hospital) (Author)
  • Hans Henning Eckstein - , Technical University of Munich (Author)
  • Matthias Trenner - , Technical University of Munich, St Josefs Hospital Wiesbaden GmbH (Author)

Abstract

Background: Beyond a certain threshold diameter, abdominal aortic aneurysms (AAA) are to be treated by open surgical or endovascular aortic aneurysm repair (EVAR). In a quarter of patients who undergo EVAR, inversion of blood flow in the inferior mesenteric artery or lumbar arteries may lead to type II endoleak (T2EL), which is associated with complications (e.g. AAA growth, secondary type I endoleak, rupture). As secondary interventions to treat T2EL often fail and may be highly invasive, prevention of T2EL is desirable. The present study aims to assess the efficacy of sac embolization (SE) with metal coils during EVAR to prevent T2EL in patients at high risk. Methods: Over a 24-month recruitment period, a total of 100 patients undergoing EVAR in four vascular centres (i.e. Klinikum rechts der Isar of the Technical University of Munich, University Hospital Augsburg, University Hospital Dresden, St. Joseph’s Hospital Wiesbaden) are to be included in the present study. Patients at high risk for T2EL (i.e. ≥ 5 efferent vessels covered by endograft or aneurysmal thrombus volume <40%) are randomized to one group receiving standard EVAR and another group receiving EVAR with SE. Follow-up assessments postoperatively, after 30 days, and 6 months involve contrast-enhanced ultrasound scans (CEUS) and after 12 months an additional computed tomography angiography (CTA) scan. The presence of T2EL detected by CEUS or CTA after 12 months is the primary endpoint. Secondary endpoints comprise quality of life (quantified by the SF-36 questionnaire), reintervention rate, occurrence of type I/III endoleak, aortic rupture, death, alteration of aneurysm volume, or diameter. Standardized evaluation of CTA scans happens through a core lab. The study will be terminated after the final follow-up visit of the ultimate patient. Discussion: Although preexisting studies repeatedly indicated a beneficial effect of SE on T2EL rates after EVAR, patient relevant outcomes have not been assessed until now. The present study is the first randomized controlled multicentre study to assess the impact of SE on quality of life. Further unique features include employment of easily assessable high-risk criteria, a contemporary follow-up protocol, and approval to use any commercially available coil material. Overcoming limitations of previous studies might help SE to be implemented in daily practice and to enhance patient safety. Trial registration: ClinicalTrials.gov NCT05665101. Registered on 23 December 2022.

Details

Original languageEnglish
Article number17
Number of pages12
JournalTrials
Volume25 (2024)
Issue number1
Publication statusPublished - 2 Jan 2024
Peer-reviewedYes

External IDs

PubMed 38167068

Keywords

Keywords

  • Aortic aneurysm, Embolization, Endoleak, Endovascular, Prevention, Prospective studies, Endovascular Aneurysm Repair, Blood Vessel Prosthesis Implantation/adverse effects, Humans, Endovascular Procedures/adverse effects, Risk Factors, Treatment Outcome, Randomized Controlled Trials as Topic, Embolization, Therapeutic/adverse effects, Multicenter Studies as Topic, Quality of Life, Retrospective Studies, Aortic Aneurysm, Abdominal/diagnostic imaging, Endoleak/diagnostic imaging

Library keywords