Comparing Sac Embolization and Inferior Mesenteric Artery Embolization in Preventing Type II Endoleaks Post-EVAR

SACE is more effective than IMAE in preventing pT2EL and promoting sac shrinkage in high-risk EVAR patients. These results support SACE as the preferred adjunctive strategy, warranting further multicenter studies with longer follow-up to confirm its benefits and optimize techniques.Clinical ImpactThis study provides comparative evidence on two adjunctive techniques used during EVAR for high-risk patients. Sac embolization (SACE) demonstrated a lower incidence of persistent type II endoleaks and a higher rate of aneurysm sac shrinkage compared with inferior mesenteric artery embolization (IMAE), with reduced contrast use and comparable safety. These findings suggest that SACE may offer a more effective and practical approach for type II endoleak prevention and sac regression, potentially improving long-term outcomes and procedural efficiency in EVAR practice.