Endovascular Treatment of Delayed Type 1 and 3 Endoleaks

Introduction A significant proportion of patients undergoing endovascular aneurysm repair (EVAR) have common iliac artery aneurysms (CIAA). Aneurysmal involvement at the iliac bifurcation potentially undermines long-term durability. Methods Patients who underwent EVAR with CIAA were identified in two teaching hospitals. Bell-bottom technique (iliac limb ≥ 20mm) (BBT) or internal iliac artery embolization and limb extension to the external iliac artery (IIE+EE) were used. Outcome between these two approaches are compared. Results One hundred and eighty five patients were identified. . Indication for EVAR included asymptomatic AAA (n=157), symptomatic or ruptured aneurysm (n=19), and common iliac artery aneurysm (n=9). Mean AAA diameter was 59 mm. A total of 260 large CIAAs were treated. One hundred and sixty six CIAA limbs were treated with BBT, 94 limbs underwent IIE+EE. Total reintervention rates were similar for BBT (n=19, 11%) and IIE+EE (n=18, 19.1%) (p=0.149). Similar rates of reintervention for type 1b or 3 endoleak are reported, BBT (n=7, 4%) versus IIE+EE (n=4, 4%) (p=1.0). There was no significant difference in limb patency rates. Thirty-day mortality was 1%. Median follow-up was 22 months. While there was no significant difference in complications between the two groups the combined incidence of perioperative complications and reinterventions was higher in the IIE+EE group (49% versus 22%, p-0.002). Conclusion The combined incidence of perioperative complications and reinterventions is significantly higher in the IIE+EE when compared with the BB technique. Therefore, when feasible, BB is desirable..

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“…22 In our experience of endovascular reintervention following EVAR, type 1b endoleak was the most common indication for reintervention. 4 …”

Section: Discussionmentioning

confidence: 99%

“…Poor patient or stent-graft selection undermines the effectiveness of EVAR. 4 Various pre-, intra-, and postoperative factors may compromise repair. To date, most studies report the outcome of EVAR in patients with adverse morphological features at the proximal seal, including neck angulation, diameter, and thrombus.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of the bell-bottom technique vs hypogastric exclusion for the treatment of aneurysmal extension to the iliac bifurcation

Naughton

Park

Kheirelseid

et al. 2012

Journal of Vascular Surgery

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“…There are several treatment methods for type I endoleaks, and results with endovascular treatment have been encouraging [9]. Proximal stent graft extension, insertion of a Palmaz stent, and coil embolization can be attempted.…”

Section: Discussionmentioning

confidence: 99%

“…Type I endoleaks are known to be associated with high sac pressure, aneurysmal dilatation, and rupture of aneurysm, therefore treatment at the time of diagnosis is recommended [5,7]. However, 50%-60% of the leaks at completion of EVAR were reported to close spontaneously within the first postoperative month [8,9]. In a study of 28 patients with periprosthetic leaks, including 23 type I endoleaks, 50% of the type I endoleaks spontaneously sealed [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of type I endoleak on completion angiography

Kim

Min

et al. 2014

Ann Surg Treat Res

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PurposeType I endoleak is known to be associated with sac enlargement and occasional rupture, therefore, the treatment of type I endoleak is recommended at the time of diagnosis. The aim of this study was to identify the significance of early type I endoleak found on completion angiography.MethodsBetween January 2000 and December 2012, a total of 86 patients underwent endovascular abdominal aortic aneurysm repair (EVAR) and 10 patients (11.6%) were diagnosed with type Ia endoleak on completion angiography. Clinical and radiologic data were reviewed retrospectively.ResultsOf the 10 patients, two underwent EVAR with custom-made stent-grafts in the initial stage and both of them needed immediate treatment: one case involved open repair while the other involved insertion of an additional stent-graft. In 8 patients, the amount of leakage decreased after repeated balloon molding. They were managed conservatively and followed up with computed tomography angiography within 2 weeks after EVAR. In 7 of the 8 cases, type Ia endoleaks disappeared. In one patient with a persistent endoleak and a folded posterior wall of the stent-graft, coil embolization was performed 1 week after EVAR. With a median follow-up of 12 months (range, 1-61 months), no patients showed recurrence of type I endoleak or sac expansion.ConclusionType I endoleaks diagnosed on completion angiography sealed spontaneously in 7 of 10 patients (70.0%). In cases of decreased amounts of leakage after balloon molding, simple observation may be an alternative to repetitive procedures. The long-term follow-up of patients with self-sealed type I endoleaks is mandatory.

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“…The reported incidence of endoleaks varies from 2.3 to 50% [5]. Type III endoleaks arise from a defect in the graft fabric, inadequate seal or separation of modular graft component [6].…”

Section: Discussionmentioning

confidence: 99%