Objective: Type II endoleaks (T2EL) are common complications after fenestrated or branched endovascular aortic repair (F/BEVAR) and occur typically through the inferior mesenteric artery (IMA) and lumbar arteries (LA). Accessory renal arteries (aRAs) are found in about one-third of patients. The aim of this study was to investigate whether patients with aRAs are at higher risk of T2EL-related complications than those without aRA.
Methods: All patients treated with F/BEVAR at Karolinska University Hospital during 2009-2022 were included in this single-center cohort study with prospectively collected data. Patients with at least one aRA ≥2 mm were compared to those without aRA. Furthermore, patients with aRA were subdivided into groups depending on the location of the origin (neck vs sac). Endpoints included change in maximal aortic diameter, incidence of T2EL, reinterventions, and overall mortality during follow-up. All CT scans were reviewed preoperatively, 30 days postoperatively, and at 1, 3, and 5 years after the procedure.
Results: A total of 199 consecutive patients treated with F/BEVAR were included, 76.4% male, mean age 74 years. Fifty-one patients (25.6%) had at least one aRA ≥2 mm, and 148 patients (74.4%) had no aRA ≥2 mm. The median aneurysm diameter at baseline was 61 mm in both groups (with and without aRA, p=0.468). There were no significant differences in comorbidities or demographic details between the groups. At 3 years, patients with aRA had a larger increase in maximal aortic diameter (+4 mm vs -7.5 mm, p=0.004) and a higher incidence of T2ELs (50% vs 17.9%, p=0.019) as compared to patients without aRA. Reinterventions due to T2EL was also higher in the aRA group (29.6% vs 10.9%, p=0.011). Overall mortality did not differ between the groups.
Conclusions: The presence of at least one aRA ≥2 mm is associated with an increased risk of persistent T2EL, sac expansion, and need for reinterventions.Clinical ImpactIn this single-centre series of 199 consecutive F/BEVAR procedures, accessory renal arteries ≥2 mm were independently associated with an increased risk of aneurysm sac expansion and subsequent reintervention. In particular, accessory renal arteries originating from the aneurysm sac were correlated with treatment failure and should be considered for preemptive embolization at the time of the index procedure.
Keywords: accessory renal arteries; aortic aneurysm; endoleak; endovascular aortic repair; reintervention; sac enlargement.