Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience

Abstract

phology. One of the remaining concerns is uncertainty about the long-term effect of persistent blood flow within the aneurysm sac after endovascular grafting, an occurrence known as endoleak. 1 In fact, endoleak development constitutes one of the prime reasons to perform postoperative surveillance by regularly performed image studies, usually computed tomography (CT) scanning. [2][3][4] The main purpose of EAR is to prevent death from rupture of the aneurysm, and early identification of endoleaks is intended to help obtain this goal. Protocols for when and how to manage endoleaks have been suggested, despite conflicting opinions on the natural history of endoleaks. 5 Several investigators consider the presence of perigraft flow to be evidence of failed treatment because it may predict aneurysmal enlargement and eventual rupture. 6-8 A contrasting opinion was presented in a recent study in which no relation between early endoleaks and late rupture, conversion to open surgery, and death could be demonstrated. 9 From this latter report, it might be concluded that the observation of perigraft flow had little consequence for the ultimate fate of the patient.Clinical management of endoleak may differ between types of endoleak. A generally accepted classification dis-Although the durability of endovascular repair of abdominal aortic aneurysms (AAAs) (EAR) is not definitively established, this treatment method is increasing in popularity among patients and doctors. Physicians from different vascular-oriented disciplines have engaged in workshops and training sessions to learn how to perform the technique in patients with suitable aneurysm mor-461 Objective: The purpose of this study was to assess the incidence, risk factors, and consequences of endoleaks after endovascular repair of abdominal aortic aneurysm. Methods: Data on 2463 patients were collected from 87 European centers and recorded in a central database. Preoperative data were compared for patients with collateral retrograde perfusion (type II) endoleak (group A), patients with devicerelated (type I and III) endoleaks (group B), and patients in whom no endoleak was detected (group C). Only endoleaks observed after the first postoperative month of follow-up were taken into consideration. Regression analysis was performed to investigate statistical relationships between the occurrence and type of endoleak and preoperative patient and morphologic characteristics, operative details, type of device, and experience of the operating team. In addition, postoperative changes in aneurysmal morphology, the need for secondary interventions, conversions to open repair, aneurysmal rupture, and mortality during follow-up were compared between these study groups. Results: Patients in group A had a higher prevalence of a patent inferior mesenteric artery compared with patients without endoleak. Patients in group B were treated more frequently than patients in group C by an operating team with experience of less than 30 procedures. The mean follow-up period was 15.4 months. Seco...

Surgical corrections of endovascular aneurysms: Repair complications

“…In agreement with other authors, our management strategy for type II endoleak is conservative, and repair is indicated in case of hemodynamic importance with high flow and an increase in aneurysm size [27][28] . There were 14 (8.8 %) secondary type II endoleaks observed in our (Fig.…”

“…Our experience with EVAR complications requiring intervention is comparable with other presented reports. Type I endoleaks, especially the late proximal ones, are absolutely indicated for repair, and this was also the case in our patients [27][28] . In our early experience, immediate type Ia endoleaks in our patients were caused by failed stentgraft placement in the short conical neck.…”

Desarrollo de un sistema de telemetría para el seguimiento postoperatorio de procedimientos en cirugía vascular: modelo in vitro

“…Onda emitida por el microhilo al variar la tensión producida sobre un molde de silicona La amplia variabilidad de la presión del saco aneurismático tras la exclusión endovascular de un aneurisma de aorta es uno de los problemas a los que se enfrenta la cirugía endovascular actualmente. Se ha demostrado que la presencia de fugas durante el seguimiento es un factor pronóstico de complicaciones durante el seguimiento de estos pacientes (129) . Las pruebas diagnósticas disponibles en la actualidad no siempre son capaces de diagnosticar dichas fugas existiendo casos en la literatura de rupturas del saco aneurismático en ausencia de fugas (130) .…”

Treatment of endoleaks after endovascular abdominal aorta aneurysm repair

“…[1] Type 1 endoleaks are associated with an increased risk of post-procedural aneurysm rupture and late aneurysm related death, and re-intervention is recommended as soon as possible upon the diagnosis. [1] Anatomical segments of the aneurysm neck can create a predisposition for type 1 endoleaks.…”

“…[1] Type 1 endoleaks are associated with an increased risk of post-procedural aneurysm rupture and late aneurysm related death, and re-intervention is recommended as soon as possible upon the diagnosis. [1] Anatomical segments of the aneurysm neck can create a predisposition for type 1 endoleaks. [1] Several factors such as short neck, a neck degree higher than 60, thrombus or plaque in the neck wall, mural calcifications, ulcers in the neck may increase the type 1 endoleaks after the stent-graft placement.…”