IMPACT OF TYPE-II ENDOLEAK ON ANEURYSM SAC IN A SINGLE CENTER
Objective: Type 2 endoleak occurs in up to 30% of endovascular aneurysm repair (EVAR), but its long-term significance continues to be one of the most controversial topics. We reviewed our experience to evaluate late outcomes associated with type 2 endoleak.
Methods: Between January 2008 to December 2014, 57 patients undergoing EVAR were enrolled in the presenting study. Computed tomography (angioCT) scan assessment was performed to evaluate aneurysm sac evolution. Primary end points included type 2 endoleak incidence, aneurysm sac growth, abdominal aortic aneurysm (AAA) related rupture and death. Secondary endpoints included conversion to open repair, reintervention rate, type 2 endoleak persistence and failure to shrinkage > 5mm and abdominal aortic aneurysm (AAA) rupture.
Results: We identified 10 (17.5%) patients with type 2 endoleaks (6 early at the first follow-up CT scan). Median followup was 39.0 ± 31,6 months. Endoleaks persisted in 7 patients (12,2% of total patients; 70,0% of type 2 endoleaks) for >6 months. Overall survival rate was 100%, 98% and 80% at 1, 2 and 5 years. Spontaneous sealing occurred in 6/10 (60%): 3/3 (100.0%) transient type 2 endoleaks and 3/7 (43%) persistent type 2 endoleak. Transient type 2 endoleak (those that resolved <6 months of EVAR) weren´t associated with adverse late outcomes. In contrast, persistent endoleak was associated with several adverse outcomes. When evaluating patients with transitory endoleak vs persistent endoleak, freedom from sac expansion at 1, 3, and 5 years was 100% (transitory) vs 85%, 65%, e 40% (persistent) (P < .001). Patients with persistent endoleak were at increased risk for aneurysm sac growth vs patients without endoleak (odds ratio [OR], 36.0; 95% confidence interval [CI] 2,15 - 79; P < .02). The only reintervention occurred in a persistent endoleak). There was no aneurysm rupture or AAA-related death.
Conclusion: Small sample size have limited this study ability to evaluate the impact on endoleak on adverse outcomes. Persistent type II endoleaks led to significant aneurysm sac enlargement, but without increased mortality or rupture rate.
2. Gandhi RT, Bryce Y, McWikkiams J, et al. Management of Type II Endoleak. Endovascular Today April 2016; vol 15:4
3. Steinmetz, E., Rubin, B.G., Sanchez, L.A., et al. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative
approach with selective intervention is safe and cost-effective. J Vasc Surg. 2004;39:306–313.
4. Van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open
conversion and aneurysm rupture during follow-up. Eur J Vasc Endo- vasc Surg 2004;27:128-37.
5. Greenhalgh RM, Brown LC, Powell JT, et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med.
6. Gelfand DV, White GH, Wilson SE. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm.
Ann Vasc Surg 2006;20:69-74.
7. Gonçalves FB, Jairam A, Voûte MT, et al. Clinical outcome and morphologic analysis after endovascular aneurysm repair using
the Excluder endograft. J Vasc Surg 2012;56:920-8.
8. Otsu M, Ishizaka T, Watanabe M, et al. Analysis of anatomical risk factors for persistent type II endoleaks following endovascular
abdominal aortic aneurysm repair using CT angiography. Surg Today. 2016;46:48-55.
9. Löwenthal D, Herzog L, Rogits B, et al. Identification of predictive CT angiographic factors in the development of high risk type
2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms. Rofo. 2015;187:49-55.
10. Lo R.C., Buck D.B., Herrmann J. et al. Risk factors and consequences of persistent type II endoleak. J Vasc Surg. 2016 Apr;63(4):895-
11. Sheehan MK, Ouriel K, Greenberg R, et al. Are type II endoleaks after endovascular aneurysm repair endograft dependent? J Vasc
12. Parent FN, Meier GH, Godziachvili V et al. The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment
with color duplex ultrasound scan. J Vasc Surg 2002;35:474-81.
13. Jones JE, Atkins MD, Brewster DC, et al; Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated
with adverse late outcomes; J Vasc Surg 2007;46:1-8.
14. Laheij RJ, Buth J, Harris PL, et al. Need for secondary interventions after endovascular repair of abdominal aortic aneurysms.
Intermediate-term follow-up results of a European collaborative registry (EUROSTAR). Br J Surg 2000;87:1666-73.
15. Jouhannet C, Alsac J, Julia P, et al. Reinterventions for type 2 endoleaks with enlargement of the aneurismal sac after endovascular
treatment of abdominal aortic aneurysms. Ann Vasc Surg. 2014;28:192-200.
16. Sarac TP, Gibbons C, Vargas L, et al. Long-term follow-up of type II endoleak embolization reveals tht need for close surveillance; J
vasc Surg 2012; 55:33-40.
17. Mehta, M., Sternbach, Y., Taggert, J.B. et al. Long-term outcomes of secondary procedures after endovascular aneurysm repair. J
Vasc Surg. 2010;52:1442–1449.
18. Arko FR, Rubin GD, Johnson BL, et al. Type-II endoleaks following endovascular AAA repair: preoperative predictors and long-term
effects. J Endovasc Ther 2001;8:503-10.
19. Jonker, F.H.W., Aruny, J., Muhs, B.E. Management of type II endoleaks: preoperative versus postoperative versus expectant
management. Semin Vasc Surg. 2009;22:165–171.