Risk Factors for Early and Late Type Ib Endoleak Following Endovascular Abdominal Aortic Aneurysm Repair

Choi, Eun Sun; Lee, Sang Ah; Ko, Gi Young; Kim, Nayoung; Cho, Yong Pil; Kwon, Tae-Won

doi:10.1016/j.avsg.2020.08.144

Cited by 10 publications

(3 citation statements)

References 35 publications

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“…Late complications of EVAR, along with the need for re-intervention, have been prominent concerns in this field [ 2 , 8 - 11 ]. While endoleaks have received significant attention in previous studies, little was known about endotension until recent years, primarily due to its rarity.…”

Section: Discussionmentioning

confidence: 99%

Endotension Following Endovascular Aneurysm Repair: Retrospective Review of Treatment and Clinical Outcome

Kim,

Lee,

Gwon

et al. 2024

Vasc Specialist Int

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Purpose Endotension is a rare late complication characterized by an increase in sac size without any type of endoleak following endovascular aortic aneurysm repair (EVAR). Due to its rarity, few studies have demonstrated the mechanism behind and the management of endotension. In this study, we aimed to better understand the treatment and the long-term outcome of endotension in a single-center cohort. Materials and Methods This study was designed for a retrospective review of the patients diagnosed with endotension between January 2006 and December 2017. The study patients were categorized into two groups (primary versus secondary) based on the presence of any type of endoleak before the diagnosis of endotension. We collected data related to endotension treatment, intraoperative findings, and long-term outcomes. Results In a cohort of 15 patients diagnosed with endotension following EVAR, eight were classified into the primary endotension (PE) group without prior endoleak, and seven exhibited secondary endotension (SE). Among the eight PE patients, endovascular intervention for a preemptive purpose was conducted in six patients; however, three (50%) showed continuous sac expansion and finally received open conversion. Overall, eight patients (five in PE and three in SE) underwent open conversion, and one (12.5%) presented with an undetected endoleak during the operative findings. Postoperative morbidity was observed in three patients with no operative mortality. Conclusion Endotension can be managed initially through simple observation for changes on serial images, along with preemptive endovascular intervention. However, surgical intervention should be considered for patients with specific indications including continuous aneurysm sac enlargement, presence of symptoms, suspicions of migration of stent-graft with endoleak, and infection.

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Section: Discussionmentioning

confidence: 99%

Endotension Following Endovascular Aneurysm Repair: Retrospective Review of Treatment and Clinical Outcome

Kim,

Lee,

Gwon

et al. 2024

Vasc Specialist Int

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“…Late degeneration of iliac vessels following EVAR is a well-described phenomenon. 11,12 This is especially true in cases where flared or "bell-bottom" iliac limbs were used at the index EVAR procedure in order to seal in ectatic or even aneurysmal iliac landing zones, 13,14 leaving patients at risk for development of type Ib endoleaks and aneurysm rupture. Of course, the best practice is to consider iliac branch use at the time of EVAR whenever the common iliac artery is significantly dilated.…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral Iliac Branch Repair Using a Looped Wire, Precannulated Gate Technique

et al. 2021

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Purpose To describe a novel, entirely ipsilateral femoral technique for distal endograft extension using the Gore Iliac Branch Endoprosthesis. Technique Femoral arterial access is obtained on the side of the intended repair, and a 16F sheath is inserted over a stiff wire. A looped wire is used to pre-cannulate the internal gate of the IBE device prior to insertion, and the device is then positioned and deployed. This through-wire guides access over the IBE flow divider and into the internal gate with a steerable sheath. The internal iliac artery is then selected, and a Viabahn VBX balloon-expandable stent (W.L. Gore, Flagstaff, AZ) is advanced into position and deployed. We present the successful completion of this technique in 4 patients. Conclusion This novel technique allows distal endograft extension with an IBE device using only ipsilateral femoral access and is particularly useful for patients with aneurysmal iliac degeneration in the setting of prior open or endovascular aneurysm repair. This eliminates the need for upper extremity access or contralateral femoral access and navigation across the steep flow divider.

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“…Further, large infrarenal neck diameters (≥30 mm) require 34- to 36-mm endografts and are increasingly recognized to be a risk factor for type IA endoleaks and stent migration . Additionally, short or ectatic common iliac arteries and short distal sealing lengths increase the risk for type IB endoleaks …”

Section: Type I Endoleaksmentioning

confidence: 99%

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

et al. 2023

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ImportanceEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms, encompassing 80% of all repairs in the United States. Endoleaks are ubiquitous and affect 30% of patients treated by EVAR, potentially leading to sac enlargement and increased risk of rupture. The care of EVAR patients requires long-term surveillance by a multidisciplinary team. Accordingly, physicians should be familiar with the fundamentals of endoleak management to achieve optimal outcomes, including timely referral for remediation or providing counseling and reassurance when needed.ObservationsPubMed and the Cochrane database were searched for articles published between January 2002 and December 2022 in English, addressing epidemiology, diagnosis, and management of endoleaks after EVAR. Endoleaks can be detected intraoperatively or years later, making lifelong surveillance mandatory. Type I and III have the highest risk of rupture (7.5% at 2 years and 8.9% at 1 year, respectively) and should be treated when identified. Intervention should be considered for other types of endoleak when associated with aneurysm sac growth larger than 5 mm based on current guidelines. Type II endoleaks are the most common, accounting for 50% of all endoleaks. Up to 90% of type II endoleaks resolve spontaneously or are not associated with sac enlargement, requiring only observation. Although the risk of rupture is less than 1%, cases that require reintervention are challenging. Recurrence is common despite endovascular treatment, and rupture can occur without evidence of sac growth. Type IV endoleaks and endotension are uncommon, are typically benign, and primarily should be observed.Conclusions and RelevanceEndoleak management depends on the type and presence of sac expansion. Type I and III endoleaks require intervention. Type II endoleaks should be observed and treated selectively in patients with significant sac expansion. Since endoleaks can appear any time after EVAR, at least 1 contrast-enhanced computed tomographic angiogram or duplex ultrasound by an experienced laboratory is recommended every 5 years.

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Risk Factors for Early and Late Type Ib Endoleak Following Endovascular Abdominal Aortic Aneurysm Repair

Cited by 10 publications

References 35 publications

Endotension Following Endovascular Aneurysm Repair: Retrospective Review of Treatment and Clinical Outcome

Endotension Following Endovascular Aneurysm Repair: Retrospective Review of Treatment and Clinical Outcome

Ipsilateral Iliac Branch Repair Using a Looped Wire, Precannulated Gate Technique

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

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