In endovascular treatment of peripheral arterial disease, paclitaxel-coated device (PCD) have been widely used to reduce vascular restenosis, yet their safety remains controversial. Some scholars have suggested that PCD might increase long-term mortality, sparking widespread concern and debate. In recent years, a number of studies have provided support for the safety of PCD, believing that PCD have advantages in terms of re-intervention, patency rate, and reduction of amputation risk, and do not increase the risk of death. There is no direct relationship between the paclitaxel dose and mortality. Overall, the safety controversy primarily stems from methodological limitations in early studies. The latest research has provided safety evidence for their clinical application. However, further investigations are required to define the boundary conditions for their long-term safety, elucidate variations in responses across different patient populations, and clarify paclitaxel′s mechanisms of action in vivo. Such efforts will facilitate optimal balancing of therapeutic efficacy and safety in clinical applications.

In endovascular treatment of peripheral arterial disease, paclitaxel-coated device (PCD) have been widely used to reduce vascular restenosis, yet their safety remains controversial. Some scholars have suggested that PCD might increase long-term mortality, sparking widespread concern and debate. In recent years, a number of studies have provided support for the safety of PCD, believing that PCD have advantages in terms of re-intervention, patency rate, and reduction of amputation risk, and do not increase the risk of death. There is no direct relationship between the paclitaxel dose and mortality. Overall, the safety controversy primarily stems from methodological limitations in early studies. The latest research has provided safety evidence for their clinical application. However, further investigations are required to define the boundary conditions for their long-term safety, elucidate variations in responses across different patient populations, and clarify paclitaxel′s mechanisms of action in vivo. Such efforts will facilitate optimal balancing of therapeutic efficacy and safety in clinical applications.

Abdominal aortic aneurysm (AAA) is a type of aneurysmal aortic disease with a high mortality rate. Endovascular aneurysm repair (EVAR) is an effective treatment for this condition,but endoleaks can occur intraoperatively or years after the procedure,necessitating lifelong monitoring. Type Ⅱ endoleak (T2EL) is a major complication of EVAR,primarily caused by persistent retrograde perfusion of the aneurysm sac from collateral vessels such as the inferior mesenteric artery (IMA) and lumbar arteries (LA). The occurrence of T2EL is closely related to patient anatomical factors (e.g.,the diameter,number,and patency of collateral vessels),surgical factors (e.g.,the degree of stent graft adherence to the arterial wall),and systemic factors such as hypertension. Persistent T2EL may lead to aneurysm sac enlargement and increased risk of rupture,thereby adversely affecting patient prognosis. In recent years,prophylactic embolization of the IMA and LA has shown certain advantages in reducing the incidence of T2EL,aneurysm sac enlargement,and reintervention rates,contributing positively to improving treatment outcomes and quality of life of the patients. Here,the authors reviewed literature published between January 2002 and July 2024 on the epidemiology of endoleaks following EVAR and the use of IMA and LA embolization during EVAR to prevent T2EL. The current research was summarized to discuss the clinical value of prophylactic IMA and LA embolization in patients at high risk of T2EL.

Abdominal aortic aneurysm (AAA) is a type of aneurysmal aortic disease with a high mortality rate. Endovascular aneurysm repair (EVAR) is an effective treatment for this condition,but endoleaks can occur intraoperatively or years after the procedure,necessitating lifelong monitoring. Type Ⅱ endoleak (T2EL) is a major complication of EVAR,primarily caused by persistent retrograde perfusion of the aneurysm sac from collateral vessels such as the inferior mesenteric artery (IMA) and lumbar arteries (LA). The occurrence of T2EL is closely related to patient anatomical factors (e.g.,the diameter,number,and patency of collateral vessels),surgical factors (e.g.,the degree of stent graft adherence to the arterial wall),and systemic factors such as hypertension. Persistent T2EL may lead to aneurysm sac enlargement and increased risk of rupture,thereby adversely affecting patient prognosis. In recent years,prophylactic embolization of the IMA and LA has shown certain advantages in reducing the incidence of T2EL,aneurysm sac enlargement,and reintervention rates,contributing positively to improving treatment outcomes and quality of life of the patients. Here,the authors reviewed literature published between January 2002 and July 2024 on the epidemiology of endoleaks following EVAR and the use of IMA and LA embolization during EVAR to prevent T2EL. The current research was summarized to discuss the clinical value of prophylactic IMA and LA embolization in patients at high risk of T2EL.