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Background.: With increasing interest in the prevention of type Ⅱ endoleaks (EⅡ),the aim of this study was to report midterm results on the intraoperative coiling embolization of the periprosthetic aneurysmal sac in patients at high-risk of EⅡ.Methods: A retrospective review study was conducted with 124 patients with infrarenal abdominal aortic aneurysm who accorded with the inclusion criteria,including 66 patients who underwent standard endovascular aortic aneurysm repair (Group A) and 58 patients who underwent aneurysmal sac coiling embolization (Group B).Baseline data and follow-up results were analyzed.Results: A mean of 2.84 ± 1.45 coils (range 1-9) were used in Group B.The general incidence of an EⅡi was 15.32％ (19/124) at a mean follow-up time of 46.60 ± 15.14 months,with 22.7％ (15/66) in Group A and 6.9％ (4/58) in Group B (x2 =5.62;P =0.018).Logistic multivariate analysis revealed that the independent risk factors of an EⅡ were no sac embolization and a sac volume ≥ 128 cm3.The Kaplan-Meier subgroup analysis showed no difference in regard to the rate of freedom from EⅡ between the two groups either with a larger or smaller sac.Conclusions: These results suggest that periprosthetic coiling embolization in patients at high-risk of EⅡ is safe and effective in the prevention of EⅡ.The preventive effect seemed to be weakened when the sac volumes were taken into consideration at midterm follow-up.