Combined Type III and Type II Endoleaks after Endovascular Aneurysm Repair: Presentation of 2 Cases and a Literature Review

Theodoridis, Panagiotis G.; Staramos, Dimitrios N.; Ptochis, Nikolaos; Davos, Constantinos H.; Dodos, Ilias; Iatrou, Nikolaos; Potouridis, Anastasios; Argitis, V.; Antoniadis, Pavlos; Dervisis, Konstantinos

doi:10.1016/j.avsg.2018.06.028

Cited by 5 publications

(4 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some cases have been described in literature of combinations of type II and type III endoleaks. 24 From a technical point of view, the placement of a Nellix stent inside an EVAR device does not significantly differ from a regular EVAR. However, the required volume of polymer is lower when compared regular EVAS.…”

Section: Discussionmentioning

confidence: 99%

An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

et al. 2021

View full text Add to dashboard Cite

Introduction: Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR. Methods: This is an international, retrospective, observational cohort study including data from 8 European institutions. Results: A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5–89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%. Conclusion: The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In firstand second-generation grafts, 53% of type III endoleaks were type IIIa; in third-generation devices, 83% of type III endoleaks were type IIIa. 12,16 Of note, the Endologix AFX Endovascular Graft System was recalled by the Food and Drug Administration (FDA) in 2018 due to its high rate of type III endoleaks, and this device has since been replaced by a redesigned AFX device.…”

Section: Incidencementioning

confidence: 99%

“…12 Rarely bowel ischemia, retroperitoneal bleeding, or device component separation causing acute lower extremity ischemia can be presenting symptoms. 12,16 Early type IIIa endoleaks should be diagnosed on completion angiography, but the sensitivity and specificity of angiography is highly variable depending on the study (60-90%), and many early type IIIa endoleaks may be first seen on follow-up imaging. 22 Both computed tomographic angiography (CTA) and ultrasonography are commonly used for post-EVAR surveillance, with the diagnosis of a late endoleak being made when these images demonstrate contrast or blood flow within the sac but outside of the endograft.…”

Section: Diagnosismentioning

confidence: 99%

Review of Type III Endoleaks

Stoecker

Glaser

2020

Semin intervent Radiol

View full text Add to dashboard Cite

Endoleak remains a significant challenge to endovascular aneurysm repair, particularly as evolving techniques and devices have allowed treatment of increasingly complex aneurysm anatomy with increasing number of device components. Intervention is recommended for both type I and III endoleaks due to their risk of rupture, and endovascular techniques are the favored modality with placement of a bridging endograft over the endoleak defect. Conversion to open surgical repair remains the definitive option in cases where less invasive methods have failed or are precluded. In this article, the authors review evidence on the etiology, incidence, diagnosis, and current techniques for type III endoleak management.

show abstract

“…9 Rupture due to TIIEL is only rarely reported, accounting for less than 1% of all TIIELs. 10 Almost 10 years ago, Lath et al 11 published the oldest reported case of an AAA treated at that time, describing a 101-year-old female who was successfully operated by an open repair for a symptomatic 9-cm AAA. Recently, Nishi et al 12 reported a 103-year-old male patient with a ruptured AAA successfully treated with EVAR.…”

Section: Introductionmentioning

confidence: 99%

A Late Post-EVAR Rupture in a 102-Year-Old Patient Related to a Type II Endoleak

González-Urquijo

Reijnen

Lozano-Balderas

et al. 2020

Vasc Endovascular Surg

View full text Add to dashboard Cite

Purpose: Endovascular abdominal aortic aneurysm repair (EVAR) is progressively being applied in the elderly population. Type II endoleaks are common and mostly benign, but they are related to more aneurysm sac expansion after EVAR. They may lead to rupture in <1% of cases. We present a case of a centenarian with a post-EVAR rupture, related to type II endoleak, and discuss the use of EVAR on the management of this type of endoleak in an extremely old patient. Case Presentation: A 102-year-old man with a history of EVAR 12 years earlier, presented to the emergency department with a drop of consciousness. A computed tomography revealed a ruptured abdominal aortic aneurysm. Angiography showed a type II endoleak related to patent lumbar arteries deriving from collateral branches of the right internal iliac artery. Embolization was not successful and subsequently the ostium of the iliolumbar artery was overstented, obliterating the feeding branch. The postoperative course was complicated by a deterioration of chronic obstructive pulmonary disease and patient was discharged home on the seventh postprocedural day; nonetheless, he died on postoperative day sixteenth due to respiratory complications. Conclusion: Complications following EVAR are a real threat and emphasize the need for follow-up. The current case report shows that age per se should not be a contraindication for EVAR nor for follow-up. Also, late ruptures due to type II endoleaks could be treated in the very elderly population although larger series are required for robust conclusions.

show abstract

Combined Type III and Type II Endoleaks after Endovascular Aneurysm Repair: Presentation of 2 Cases and a Literature Review

Cited by 5 publications

References 20 publications

An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

Review of Type III Endoleaks

A Late Post-EVAR Rupture in a 102-Year-Old Patient Related to a Type II Endoleak

Contact Info

Product

Resources

About