Predictive factors for endoleaks after thoracic aortic aneurysm endograft repair

Abstract

The diameter of the aneurysmal aorta and the position of the landing zone are independent predictors of endoleak occurrence after thoracic stent-graft procedures. A careful follow-up program should be considered in patients in whom these indices are unfavorable, because most of the endoleaks may be successfully and promptly treated by additional endovascular procedures.

Examination of factors in type I endoleak development after thoracic endovascular repair

“…Different predictors of endoleak have been analyzed in the literature, 5,6,8,9,[20][21][22] including male gender, larger aneurysm size, length of aorta covered by the stent graft, number of stents used, proximal landing zone, and aortic arch morphology. The predictive value of a number of these factors is still controversial, notably aorta length covered by stent graft, considered protective of proximal endoleak by Verhoye et al 9 and, on the contrary, predictive of endoleak by Parmer et al and Morales et al 21,22 In all these studies, results were based only on univariable analysis.…”

“…Whereas studies reporting the incidence of endoleak after thoracic endovascular aortic repair (TEVAR) [3][4][5][6][7][8][9] include data of both emergently and electively treated patients, the impact of an emergency indication on endoleak occurrence has not yet been extensively analyzed. This study aimed to investigate the effect of the emergency setting on occurrence of persistent or new developing type I endoleak and to analyze the role played by different morphologic and stent graft-related factors as potential determinants of endoleak.…”

Aortic hemiarch hybrid repair

“…2,6,7,13 On the other hand, hemiarch repair has a significant risk of technical failure, especially for zone 1, by development of primary type Ia endoleak. 7,9,[15][16][17][18] Published data are mainly available on comparison of zone 0 vs zone 1, whereas data on zone 2 repair were mostly excluded from analysis. 4,13 Hence, there is little knowledge for rating hemiarch repair for zone 2 in shortand long-term outcome compared with more extended reconstruction types.…”

Delayed Graft Dislocation After Thoracic Aortic Endovascular Repair

“…[1][2][3] Therefore, it remains clear that imaging surveillance is required to detect post-procedural complications, especially those specifically related to the device itself such as endoleaks, material fatigue, persistent sac growth, and last but not the least endograft (EG) migration. 4,5 Endograft migration has been defined as the loss of positional stability resulting from the pulsatile forces of blood flow. 6 Late migration of the EG has been reported to occur in a wide range of 0% to 30% of patients, and was more frequently associated with first-generation devices, even or not in association with neck dilatation and device kinking.…”

“…6 Late migration of the EG has been reported to occur in a wide range of 0% to 30% of patients, and was more frequently associated with first-generation devices, even or not in association with neck dilatation and device kinking. [4][5][6][7] Currently, different U.S. pivotal trials have tested the presence of an endoleak, type of sac reperfusion, aneurysm expansion, and endoleak intervention. The CT-A examinations were evaluated on workstations by a team of a vascular surgeon and an interventional radiologist, using multiplanar reformatting capabilities and MIP/ MPR/3D reconstruction to identify and classify the type of complication.…”