Role of type II endoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms

Kray, Jared; Kirk, Spencer; Franko, Jan; Chew, David K.

doi:10.1016/j.jvs.2014.11.003

Cited by 48 publications

(44 citation statements)

References 10 publications

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“…12 Kray et al 36 had also reported that a preoperatively patent IMA was associated with increased rates of type II endoleak and AAA sac expansion, suggesting that consideration should be given to preoperative occlusion of a patent IMA before EVAR. 36 In a recent study, Manunga et al 12 reported that preoperative embolization of the IMA protects against the development of type II endoleaks and secondary interventions and may potentially lead to a rapid aneurysmal sac regression. 12 In our study, only cases with IMA-related type II endoleak were included.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of type II endoleak after endovascular aortic aneurysm repair

Σπανός¹,

Tsilimparis²,

Larena‐Avellaneda³

et al. 2017

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of type II endoleak after endovascular aortic aneurysm repair

Σπανός¹,

Tsilimparis²,

Larena‐Avellaneda³

et al. 2017

Journal of Vascular Surgery

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“…9,17,18 Even when feeding patent vessels are not clearly present, but when there is evidence of sac enlargement, authors have shown concern about the risk of rupture and the evolution of sac dimensions.…”

Section: Discussionmentioning

confidence: 99%

Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement

Mangialardi

Ronchey

Orrico

et al. 2015

Journal of Vascular Surgery

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Objective: The goal of this study was to present open surgical conversion with graft salvage or "semiconversion" as a definitive and safe treatment for untreatable and persistent type II endoleaks causing sac enlargement after endovascular aneurysm repair. Methods: Between January 2001 and December 2014, 25 of 1623 endovascular aortic repair (EVAR) patients were selected as candidates for open semiconversion. The indication was persistent type II endoleak in 13 patients (12 of whom received previous attempts of embolization), type I and II endoleak in 2 patients, and sac growth without imaging evidence of endoleak in the other 10. After the infrarenal aorta was prepared (via a retroperitoneal access, whenever possible), the technique consisted of performing a banding of the neck with Teflon (DuPont, Wilmington, Del), a sacotomy to remove the thrombus or the hygroma, or both, and then suturing all of the feeding vessels that were found. Proximal and distal fenestrations were performed to avoid sac repressurization. Results: The semiconversion was performed after a mean of 74 months after the initial EVAR. The mean aneurysm size at the time of the EVAR was 6.0 cm (range, 5.0-9.5 cm), and the mean aneurysm size at the time of the semiconversion was 7.7 cm (range, 5.5-11.5 cm). The overall aneurysm size increase was 38%, and the average growth rate was 8.2% per year. One patient had a stable aneurysm size but was treated because of an emergency condition. Technical success was 100%, with resolution of the endoleak and no perioperative deaths. Four cardiac deaths were registered at 12, 26, 30, and 60 months (mean follow-up, 42 months; range, 1-80 months). Conclusions: Graft salvage appears to be a valid option compared with open repair when considering treatment of persistent type II endoleak. This case series shows that semiconversion is a safe and effective treatment for otherwise untreatable type II endoleak. (J Vasc Surg 2015;62:1437-41.)

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“…New type II endoleaks detected after one year were associated with aneurysm enlargement; however, endoleak was not associated with increased mortality [38]. Contradictory findings were reported in a smaller (n = 191) retrospective study, which showed that patients with type II leak had less aortic sac regression compared to patients with no leak [39]. This study had only 6-month follow-up however.…”

Section: N/a Secondary Endograft or Explantmentioning

confidence: 70%

“…Another study found that ≥6 efferent patent vessels were a risk factor for persistent type II endoleak [42]. Furthermore, those patients with an occluded IMA (by embolization or chronically occluded) had significantly lower rates of type II endoleak and higher rate of sac regression [39]. Predictors of sac expansion were shown to be endoleak, aneurysm diameter ≥60 mm, and infrarenal neck angle of 960° [43].…”

Section: N/a Secondary Endograft or Explantmentioning

confidence: 99%

Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

O’Mara

Bersin

2016

Curr Treat Options Cardio Med

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Endovascular aneurysm repair (EVAR) has become the predominant method of treatment for abdominal aortic aneurysms (AAA). The use of conscious sedation with local anesthesia and percutaneous femoral access has further decreased the morbidity of the procedure. Current devices can more effectively manage increasingly "hostile" aneurysm necks, while chimney grafts or dedicated fenestrated stent-grafts can be used for juxta-renal disease with favorable results. However, endovascular repair does present a new set of challenges, and endoleaks remain an area of concern. While there is general consensus that type I and type III endoleaks require treatment, type II endoleaks are the topic of ongoing research and debate. Development of devices and techniques to prevent and treat endoleak continues to progress. Advances in contrast-enhanced ultrasound are reducing reliance on computed tomography for post-operative monitoring. This is an important step in this population at high risk for the development of kidney failure. Despite these many innovations, further research is needed to optimize the care of patients with AAA.

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Role of type II endoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms

Abstract: The presence of persistent EL-2 after EVAR results in inferior AAA sac regression. A preoperatively patent IMA is associated with increased rates of EL-2 and inferior AAA sac regression. Consideration should be given to preoperative occlusion of a patent IMA before EVAR.

Cited by 48 publications

References 10 publications

Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of type II endoleak after endovascular aortic aneurysm repair

Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of type II endoleak after endovascular aortic aneurysm repair

Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement

Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

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