When the facts change, change your practice.

“Take nothing on its looks; take everything on evidence. There’s no better rule.”

Charles Dickens, Great Expectations

In this useful addition to the literature, Väärämäki et al. compare a strategy of prophylactic inferior mesenteric artery (IMA) embolisation during endovascular aneurysm repair (EVAR) with standard EVAR (with no routine IMA embolisation) in individuals undergoing elective EVAR for abdominal aortic aneurysm (AAA).1 This novel study compared 732 patients from two academic vascular units in Finland with similar approaches to elective EVAR for AAA except in management of a patent IMA: one unit (395 patients) routinely attempted IMA embolisation during EVAR and the other (337 patients) did not. The authors found similar rates of sac size expansion, re-intervention, overall survival, and post-EVAR rupture across a mean follow up of more than five years, despite lower rates of type II endoleak on completion angiography and first EVAR surveillance scan in the routine IMA embolisation group. The authors concluded that prophylactic IMA embolisation during EVAR provides no clinical benefit and should not be performed.