Ensuring Reproducibility in Endovascular Aneurysm Repair: Clinical Impact of Prophylactic Branch Embolization in a Low-Volume Setting.

OBJECTIVES: Although prophylactic branch embolization is known to reduce Type II endoleak after endovascular aneurysm repair (EVAR), its reproducibility and clinical value in low-volume regional centers remain under-discussed. This study evaluated the efficacy of an anatomy-guided embolization strategy for improving long-term sac behavior. METHODS: This retrospective, single-center cohort study included 132 patients who underwent elective EVAR. Prophylactic embolization (Coil+ group, n = 30) was performed based on standardized anatomical criteria, while 102 patients underwent standard EVAR (Coil- group). Preoperative anatomical risks and mid-term clinical outcomes, including sac expansion and re-intervention rates, were compared. RESULTS: Preoperatively, the Coil+ group showed significantly higher anatomical risk than the Coil- group, including a higher prevalence of a patent inferior mesenteric artery (IMA) (90.0% vs. 69.6%; p = 0.031) and a greater mean IMA diameter (3.18 ± 0.73 mm vs. 2.76 ± 0.77 mm; p = 0.011). The Coil+ group achieved a 0% sac expansion rate at 24 months. Notably, the 5-year re-intervention rate was 0% (0/30) in the Coil+ group compared to 10.8% (11/102) in the Coil- group, representing a trend toward superior mid-term durability (p = 0.069). CONCLUSIONS: Standardized prophylactic branch embolization was associated with durable sac stability. This proactive approach may offer a rational pathway for optimizing long-term outcomes, even in low-volume centers.