This review maps 260 original studies and 80,624 participants into a practical evidence layer on where coil embolization helps in aortic aneurysm repair — especially type II endoleak prevention, sac behavior, and staged spinal-cord-protection strategies. It also shows the trade-offs that matter clinically: recurrent endoleaks, buttock claudication, radiation exposure, infection risk, coil migration, and when coils, plugs, Onyx, NBCA, or anatomy-driven alternatives may be preferable.
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Abstract: To synthesize current evidence on the efficacy, safety, and clinical outcomes of coil embolization in the management of abdominal and thoracic aortic aneurysms, focusing on its roles in endoleak prevention, spinal cord protection, and the treatment of complex vascular pathologies. The review utilises 260 original studies with 80624 total participants (topic deduplicated ΣN). The mapped evidence indicates that coil embolization functions as a versatile adjunct across the aortic aneurysm treatment pathway, with the strongest signal supporting preemptive inferior mesenteric and lumbar artery embolization to reduce type II endoleak rates (e.g., 1.3% versus 60.4%) and to improve midterm freedom from sac expansion. Multistage strategies in complex thoracoabdominal FB-EVAR, including proximal thoracic aortic repair, temporary aneurysm sac perfusion, minimally invasive segmental artery coil embolization, and combined approaches, were associated with lower mortality or permanent paraplegia of 6% versus 14% compared with single-stage repair. Dedicated segmental artery coil embolization studies separately support feasibility and short-term spinal-cord-protection rationale. Across topics, the evidence also highlights meaningful trade-offs, including buttock claudication after internal iliac coiling reaching 52.9% in bilateral cases, variable durability of established type II endoleak treatment with recurrence around 30%, and an association between hypogastric coiling and stent-graft infection (odds ratio 3.22). False-lumen and candy-plug strategies in chronic dissection, transcaval and translumbar approaches for refractory endoleaks, and coil-in-plug or microvascular plug techniques were recurrent practical signals supporting individualized, anatomy-driven device selection. Clinically, this suggests that coil embolization should be deployed selectively, balancing endoleak prevention and spinal cord protection against ischemic, radiation, and infection risks, while recognizing that the evidence base is dominated by heterogeneous retrospective series. Future research should prioritize prospective, standardized comparative trials of embolic agents, optimal coil density thresholds, and timing of staged segmental artery occlusion to clarify durable benefit and refine patient selection.
Final search date and database lock: 2026-05-01 21:52:09 CEST
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 1672
Downloaded Abstracts/Papers: 1000
Included original and non-original Abstracts/Papers (all): 290
Included original Abstracts/Papers (Vote counting by direction of effect): 262
Reference Index (links used in paper): 123
Total participants (topic deduplicated ΣN): 80624
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Reference Index (123)
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