Clinical significance of type I endoleak on completion angiography

Hass

Journal of the American College of Surgeons

et al. 2017

BACKGROUND Post-endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzed management and late outcomes of these endoleaks. STUDY DESIGN This was a retrospective review of prospectively collected data from EVAR patients during a 10-year period. All post-EVAR type Ia endoleaks on completion angiogram were identified (group A) and their early (30-day) and late outcomes were compared with outcomes of patients without endoleaks (group B). Kaplan-Meier analysis was used for survival analysis, sac expansion, late type Ia endoleak, and reintervention. RESULTS Seventy-one of 565 (12.6%) patients had immediate post-EVAR type Ia endoleak. Early intervention (proximal aortic cuffs and/or stenting) was used in 56 of 71 (79%) in group A vs 31 of 494 (6%) in group B (p < 0.0001). Late type Ia endoleak was noted in 9 patients (13%) in group A at a mean follow-up of 28 months vs 10 patients (2%) in group B at a mean follow-up of 32 months (p < 0.0001). Late sac expansion and reintervention rates were 9% and 10% for group A vs 5% and 3% for group B (p = 0.2698 and p = 0.0198), respectively. Freedom rates from late type Ia endoleaks at 1, 3, and 5 years for group A were 88%, 85%, and 80% vs 98%, 98%, and 96% for group B (p < 0.001); and for late intervention, were 94%, 92%, and 77% for group A, and 99%, 97%, and 95% for group B (p = 0.007), respectively. Survival rates were similar. CONCLUSIONS Immediate post-EVAR type Ia endoleaks are associated with higher rates of early interventions, late endoleaks and reintervention, which will necessitate strict post-EVAR surveillance.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes

Hass

Journal of the American College of Surgeons

et al. 2017

“…These endoleaks are secondary to poor apposition of the body of the stent graft to the wall of the aorta, resulting in a high-pressure leak of pulsatile blood into the aortic sac. 7,8 The options for management of these endoleaks include placement of an aortic cuff cephalad to the existing main body of the stent graft; placement of a bare Palmaz stent to improve the seal; placement of sealing coils to attach the wall of the graft to the wall of the aorta; coil embolization of the leak; and open surgical repair. 9 The most challenging problem in the management of type I-A endoleaks is the presence of visceral arteries closely adjacent to the graft attachment site (renal arteries and superior mesenteric artery).…”

Section: Type I-a Endoleak Managementmentioning

confidence: 99%

“…4a-d). 8,9 The technique requires state-of-the-art fluoroscopic equipment, and advanced catheter and microcatheter skills.…”

Section: Type I-a Endoleak Managementmentioning

confidence: 99%

Hydrogel-Coated Coils: Product Description and Clinical Applications

Ferral

2015

Semin intervent Radiol

Hydrogel-coated coils are truly detachable coils with a platinum core covered with hydrogel. The coils are available in 0.018- and 0.035-in systems. These coils have the ability to expand up to four times their size ∼20 minutes after deployment, thus providing a very effective mechanical vascular occlusion effect. The vessel-occlusive effect of these coils is a volume, space-occupying effect, not a thrombotic effect, as seen in fibered coils. Hydrogel-coated coils were originally developed and designed to treat brain aneurysms; however, their use has expanded to peripheral applications. Hydrogel-coated coils have been used in the management of visceral aneurysms, high-flow vascular arteriovenous fistulae, and endoleaks after endovascular thoracic and abdominal aneurysm repair. The purpose of this article is to describe the hydrogel-coated coil system, the mechanism of action, technical details for optimal deployment, and clinical applications.

Annals of Vascular Surgery

“…type Ia endoleak could lead to devastating results 13 . For those reasons, an aggressive 7 management of intraoperative type Ia endoleak is supported by current evidence 14 , 8 although not universally accepted 15,16,17 . Occurrence of type Ia endoleak after Ovation stentgraft implantation is rare, 1 particularly in highly selected patients.…”

mentioning

confidence: 99%

Spontaneous Sealing of a Type Ia Endoleak after Ovation Stent Graft Implantation in a Patient with On-Label Aortic Neck Anatomy

Pranteda

Sirignano

Capoccia

et al. 2016

We report a case of an early type Ia endoleak after endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm by Ovation Stent Graft implantation and spontaneously resolved without further reintervention. The patient presents a conical aortic neck, but EVAR was performed within the instruction for use proposed by manufactory. At completion angiography, a low-flow type Ia endoleak was present and left untreated. Computed tomographic angiography performed on the third postoperative day showed infolding of the 2 sealing rings. The patient was dismissed without further treatment. At 3-month follow-up, the leak appeared spontaneously sealed with partial expansion of the 2 rings.