Predictive value of pre-procedural computed tomography angiogram on technical success of transarterial embolization of type II endoleak arising from the lumbar arteries.

PURPOSE To evaluate the ability of pre-procedural CTA to predict technical success of embolization of post-EVAR type II endoleak arising from a lumbar artery. MATERIALS AND METHODS All patients at a single academic institution who underwent angiography with possible embolization for a lumbar supplied post-EVAR type II endoleak from 2009-2018 were retrospectively reviewed. Patients without pre-procedure CTA were excluded. CTAs were reviewed for the ability to trace the entire course of a feeding vessel from the internal iliac artery (IIA) to the lumbar artery at the site of endoleak. Procedural imaging was reviewed for technical success, defined as catheterization of the aneurysm sac through a lumbar artery and sac embolization. RESULTS Fifty-seven angiograms with a type II endoleak and suspected feeding lumbar artery were identified. The arterial path supplying this lumbar artery could be traced from the IIA to the aneurysm sac on pre-procedural CTA in 18 (32%). Embolization was technically successful in 16/18 (89%) of these procedures, compared to 10/39 (26%) in the procedures where the supplying artery could not be traced on CTA (p<0.001). CONCLUSION A potential catheter path from the IIA through the iliolumbar and lumbar arteries to the aneurysm sac can be traced on preprocedural CTA in the minority of lumbar-supplied type II endoleaks. The ability to trace these inflow vessels may predict technical success during embolization. The low rate of technical success when the feeding vessel could not be traced on CTA suggests these patients should be considered for percutaneous or transcaval sac puncture.