Aortic Side Branch Embolization before Endovascular Aneurysm Repair: Incidence of Type II Endoleak

Gould, Debby; McWilliams, Richard G.; Edwards, Richard; Martin, Janis; White, Donagh; Joekes, Elizabeth; Rowlands, P. C.; Brennan, John A.; Gilling-Smith, Geoffrey L.; Harris, Peter L.

doi:10.1016/s1051-0443(07)61913-7

Cited by 90 publications

(47 citation statements)

References 17 publications

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“…Consequently, we are not able to suggest an interventional method of preventing type II endoleaks, such as intraoperative embolization of lumbar arteries, IMA, or the aortic sac itself. All of these techniques have been attempted (15), but the facts that this strategy is timeconsuming and that the results are not encouraging have limited this practice from becoming a standard procedure.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for the development of persistent type ii endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms

Brountzos

Karagiannis²,

Panagiotou³

et al. 2011

Diagn Interv Radiol

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E ndovascular aneurysm repair (EVAR) is universally accepted as an alternative to open surgery for the treatment of infrarenal abdominal aortic aneurysms because of its association with lower perioperative mortality and morbidity (1). The main drawback of EVAR is the relatively high rate of re-interventions (approximately 20%) required during the follow-up (1); endoleaks are usually the culprit responsible for these re-interventions. Type II endoleaks are most common, with a frequency varying from 10% to 25%, in EVAR procedures (2). They are caused by retrograde perfusion of the aneurysm sac from collateral aortic branches.In the majority of cases, type II endoleaks are benign and resolve spontaneously during follow-up. However, it has been shown both clinically and experimentally that type II endoleaks are associated with increased sac pressure (3). Interestingly, in a multivariate analysis from a series of 873 patients, it was documented that type II endoleak persisting for more than six months was a significant predictor of aneurysm rupture (P = 0.03) (4). Considering the lack of regularity in imaging follow-up, especially on a long-term basis, it is obvious that a small but existing minority of patients with untreated type II endoleaks may suffer from aneurysm rupture.Several studies have investigated potential correlations between preoperative characteristics of the aortic anatomy and the development of type II endoleaks following an EVAR (5-9). Although some studies failed to identify anatomic predictors for type II endoleak development (5), others with larger numbers of patients showed that preoperative patency of the aortic branches increases the possibility of type II endoleak development (6-9). Sampaio et al. (8) have not only focused on preoperative patent arteries but have also studied the aneurysm sac thrombus load in relation to type II endoleak development.The aim of our study was to define these potentially high-risk patients that are candidates for a more intense follow-up protocol. We have specifically focused on persistent type II endoleaks (present at six months after EVAR) because these of all type II endoleaks are implicated most frequently in late adverse outcomes (4). Based on previous studies, we investigated the role of preoperative patent aortic branches and sac thrombus formation as potential predictors of persistent (longer than six months) type II endoleak development. Materials and methods Patient populationOne hundred forty-nine patients (144 males, 5 females) with infrarenal abdominal aortic aneurysm (AAA) were treated with EVAR in our institution by a team of interventional radiologists, anesthesiologists, and vascular surgeons. Only patients that strictly adhered to the INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Risk factors for the development of persistent type II endoleaks after endovascular repair of infrarenal abdominal aortic aneurysmsElias Brountzos, Georgios Karagiannis, Irene Panagiotou, Chara Tzavara, Efstathios Efstathopoulos, Nikolaos KelekisFrom the 2nd Department o...

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Section: Discussionmentioning

confidence: 99%

Risk factors for the development of persistent type ii endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms

Brountzos

Karagiannis²,

Panagiotou³

et al. 2011

Diagn Interv Radiol

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“…On the other hand this means another intervention that is technically demanding, time-consuming, and has a certain risk of complications [35]. The non-critical implementation of preoperative embolization in the clinical routine is controversial due to the high rate of spontaneous thrombosis in type 2 endoleaks [36]. However, based on the results of this study, the number and diameter of LAs can be used to identify high-risk patients in whom it seems helpful and justified to perform preoperative embolization (see Table 4).…”

Section: Vessels 51mentioning

confidence: 99%

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

Löwenthal

Herzog

Rogits

et al. 2014

Fortschr Röntgenstr

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Purpose: An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR). Materials and Methods: Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n?=?80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n?=?50). Statistical analysis comprised a univariate and multivariate analysis. Results: Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4???3.8?mm; HRG 23.6???2.5?mm; p?=?0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7???18.0?%; HRG 25.3???17.5?%; p?=?0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3?%; HRG 92.0?%; p?=?0.003) and their diameter (LRG 3.3???0.7?mm; HRG 3.8???0.9?mm; p?=?0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7???1.4; HRG 3.6???1.2; univariate: p?=?0.01; multivariate: p?=?0.006) as well as their diameter (LRG 2.1???0.4?mm; HRG 2.4???0.4?mm; univariate: p?

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“…We performed internal iliac artery embolization with coils to prevent type II endoleak. If the aneurysm involves the internal iliac artery, coil embolization of internal iliac artery is necessary to avoid retrograde perfusion of the aneurysm [9,10]. To avoid post-procedural disturbance, a controlateral internal iliac artery must be available to compensate.…”

Section: Discussionmentioning

confidence: 99%

Treatment of type I endoleak in an iliac aneurysm with balloon expandable palmaz stent

et al. 2011

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Endovascular exclusion of the peripheral arterial aneurysms with covered stent grafts have been used to decrease the operative morbidity and mortality in comorbid old patients. However, endoleaks remain a problem. The authors present a case of left common iliac artery aneurysm, which was treated by endovascular therapy. Initially, internal iliac artery was occluded with coil embolization to prevent type II endoleak. A covered self-expandable stent was used for exclusion of the aneurysm. A proximal perigraft leak was detected in control contrast injection. Palmaz balloon expandable stent was used for treatment of proximal perigraft leak. The control angiography showed complete exclusion of the aneurysm and no perigraft leak was detected in the aneurysm sac. Proximal balloon expandable stent implantation as an addition to covered stent in short and angulated necked aneurysms is technically feasible, and this technique provide a good treatment method for proximal perigraft leak.

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Aortic Side Branch Embolization before Endovascular Aneurysm Repair: Incidence of Type II Endoleak

Cited by 90 publications

References 17 publications

Risk factors for the development of persistent type ii endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms

Risk factors for the development of persistent type ii endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms

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

Treatment of type I endoleak in an iliac aneurysm with balloon expandable palmaz stent

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