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.

Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Blood Vessel Prosthesis Implantation*/adverse effects ; Endovascular Procedures*/adverse effects ; Aortic Aneurysm, Abdominal*/diagnostic imaging ; Aortic Aneurysm, Abdominal*/surgery ; Embolization, Therapeutic*/adverse effects; Humans ; Endoleak/diagnostic imaging ; Endoleak/etiology ; Endoleak/prevention & control ; Endovascular Aneurysm Repair ; Quality of Life ; Treatment Outcome ; Retrospective Studies ; Risk Factors ; Randomized Controlled Trials as Topic ; Multicenter Studies as Topic

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.
(© 2023. The Author(s).)

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01KG2128 Bundesministerium für Bildung und Forschung

Keywords: Aortic aneurysm; Embolization; Endoleak; Endovascular; Prevention; Prospective studies

ClinicalTrials.gov NCT05665101

Date Created: 20240103 Date Completed: 20240105 Latest Revision: 20240106

20240106

PMC10759747

10.1186/s13063-023-07888-8

38167068