Midterm Outcomes After Treatment of Type II Endoleaks Associated With Aneurysm Sac Expansion

Abstract

This study demonstrates that most patients require multiple reinterventions to treat type II endoleaks; specifically, lumbar artery embolization carries a low midterm success rate.

Impact of Age and Intraluminal Thrombus Volume on Abdominal Aortic Aneurysm Sac Enlargement after Endovascular Repair

“…Embolization of type II endoleak was reported to be effective for the prevention of these risks. 12,13 Additionally, various indices were previously reported as predictors of sac enlargement (endoleak, age ! 80 years, aortic neck diameter !…”

“…12,13,23,24 To prevent type II endoleak, preoperative approaches including coil embolization to the IMA and lumbar arteries should be considered in high-risk patients (lower percentage of ITV, patent IMA, and advanced age). 25 Additionally, considering the excellent outcomes of open surgical repair for AAA, we should take heed of these isolated risk factors for sac enlargement after EVAR when the optimal strategy is being decided.…”

Type II endoleak is an enigmatic and unpredictable marker of worse outcome after endovascular aneurysm repair

“…A number of other studies also suggested aortic thrombus load and patency of aortic branches as the most common important anatomic predictors of type II endoleaks. 12,[14][15][16] However, even if these suggested predictors could be identified, there is little chance to adjust their effect on risk: these are all nonmodifiable factors that do not allow effective strategies to preclude or effectively reverse type II endoleaks, which therefore appear to be unpreventable occurrences. Studies also showed that preventive coil/embolization of patent aortic branches before EVAR may be of little benefit on the occurrence of type II endoleak and aneurysm shrinkage.…”

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

“…Transarterial retrograde embolization as well as translumbar embolization was performed for patients with sac enlargement of more than 5 mm, but the technical success rate was not high (17%-44%) because of the presence of a multitude of collateral networks of aortic side branches. [18][19][20] Identification of patients at increased risk of persistent type II endoleak is still imprecise, and the occurrence of various associated adverse events has prompted some interventionists to come to accept that the best method for handling a type II endoleak is to prevent its development in the first place. Muthu, et al reported the findings of their study of routine preoperative embolization of the IMA and thrombin injection into the aneurysm sac.…”