Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective

Steinmetz, Éric; Rubin, Brian G.; Sánchez, Luis A.; Choi, Eric T.; Geraghty, Patrick J.; Baty, Jack; Thompson, Robert W.; Flye, M. Wayne; Hovsepian, David M.; Picus, Daniel; Sicard, Gregorio A.

doi:10.1016/j.jvs.2003.10.026

Cited by 170 publications

(143 citation statements)

References 43 publications

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“…In addition, the Excluder graft has a significantly higher rate of persistent (<6 months) type II endoleak (25%), compared with Ancure (Guidant, Menlo Park, Calif) and AneuRx (Medtronic/AVE, Santa Rosa, Calif). 14) In our cases, 45 out of 104 (43.3%) cases with all Excluder grafts had early type II endoleak and 14 (13.5%) had persistent type II endoleak. A number of methods for the treatment of type II endoleak have been reported.…”

Section: Discussionmentioning

confidence: 43%

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Yamada

Takahashi

Tauchi

et al. 2015

Annals of Vascular Diseases

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Purposes: Endovascular abdominal aortic aneurysm repair (EVAR) is an increasingly used method of repairing abdominal aortic aneurysm (AAA). However, the treatment of persistent type II endoleak is still a controversial issue. Five cases are reported here in which we performed open surgical repair of growing aneurysm due to persistent type II endoleak. Method: Totally 128 EVAR cases were retrospectively reviewed, which were operated in our hospital from April 2008 to October 2013. These cases were followed by periodical contrast-enhanced computed tomography (CT) after EVAR. When persistent type II endoleak caused aneurysm sac growth, we performed surgical repair method for the first line treatment. In the operation, we incised the aneurysm sac by abdominal small median incision approach and sutured lumber arteries from inside of aneurysm sac and tied inferior mesenteric artery (IMA) in addition to aneurysmorrhaphy. Contrast-enhanced CT scanning was performed in a week after open repair for the confirmation of complete treatment. Results: Five of 128 cases (3.9%) were needed to be surgically repaired because of aneurysm sac growth (>5 mm), including two ruptured AAA cases. All patients recovered uneventfully. Contrast-enhanced CT scanning performed a week after these operations showed no endoleak and intact stent grafts and reduction of the aneurysm size. Conclusion:We believe open surgical repair method of persistent type II endoleak with aneurysm expansion is secure method, and can be one of the preferable options for this life threatening complication after EVAR.Keywords: EVAR, AAA, type II endoleak, surgical repair less invasive method of abdominal aortic aneurysm (AAA) repair continues to gain popularity. Studies that compared the outcome of EVAR with open graft replacement have consistently demonstrated a significant reduction in morbidity with endovascular repair. [1][2][3][4] However, new type complications have plagued the stent graft approach, and importantly the failure to totally exclude the AAA by persistent perfusion and pressurization, defined as endoleak is one of the adverse outcomes. 5,6) Despite consensus on the treatment of type I and type III endoleak, controversy remains about the optimal strategy for the treatment of type II endoleak because each strategy has their own advantages and disadvantages. Although previous studies have shown that most type II endoleaks are benign and are rarely associated with adverse of events, 7) there are increasing reports of expanding aneurysm in the presence of type II endoleak eventually leading to aneurysm rupture. 8,9) A variety of treatment or prevention methods have been advocated. These days, the most popular approach for the treatment of type II endoleak is transarterial coil embolization or translumber embolization. Transarterial or translumber embolization often needs second interventions and close surveillances. In addition, intervention to treat endoleaks also has some risks of complications. In this point, there is a question if these methods are ...

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Section: Discussionmentioning

confidence: 43%

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Yamada

Takahashi

Tauchi

et al. 2015

Annals of Vascular Diseases

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“…A conservative approach to manage type II endoleak has been accepted because most of them are relatively benign. 17,18) Persistent type II endoleaks lead to significant aneurysmal sac enlargement, but there is no increase in mortality or rupture rates. 17,18) Persistent type II endoleak is often treated by coil embolization once the aneurysmal sac is expanded.…”

Section: Discussionmentioning

confidence: 99%

“…17,18) Persistent type II endoleaks lead to significant aneurysmal sac enlargement, but there is no increase in mortality or rupture rates. 17,18) Persistent type II endoleak is often treated by coil embolization once the aneurysmal sac is expanded. 15,19,20,21) However, eradicating all channels of blood supply to the sac is sometimes difficult because this procedure requires access to the inflow vessels, and to the communicating vessels to inflow ones, as well as the outflow vessels.…”

Section: Discussionmentioning

confidence: 99%

Late Sac Behavior after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Okada

Handa

Onohara

et al. 2016

Annals of Vascular Diseases

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Background: Sac behavior after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is considered as a surrogate for the risk of late rupture. The purpose of the study is to assess the sac behavior of AAAs after EVAR. Methods and Results: Late sac enlargement (LSE) (≥5 mm) and late sac shrinkage (LSS) (≥5 mm) were analyzed in 589 consecutive patients who were registered at 14 national centers in Japan. The proportions of patients who had LSE at 1, 3 and 5 years were 2.6% ± 0.7%, 10.0% ± 1.6% and 19.0% ± 2.9%. The proportions of patients who had LSS at 1, 3 and 5 years were 50.1% ± 0.7%, 59.2% ± 2.3% and 61.7% ± 2.7%. Multiple logistic regression analysis identified two variables as a risk factor for LSE; persistent endoleak (Odds ratio 9.56 (4.84-19.49), P <0.001) and low platelet count (Odds ratio 0.92 (0.86-0.99), P = 0.0224). The leading cause of endoleak in patients with LSE was type II. Conclusions: The incidence of LSE is not negligible over 5 year period. Patients with persistent endoleak and/or low platelet count should carefully be observed for LSE. Clinical Trial Registration: UMIN-CTR (UMIN000008345).

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“…The natural course of type 2 endoleak is unclear, with some tending to resolve spontaneously, others persisting without causing clinical symptoms, and a small proportion causing a significant increase in sac size. [18][19][20] Therefore, a close follow-up is suggested in type 2 endoleaks, even in cases without aneurysm sac enlargement.…”

Section: Discussionmentioning

confidence: 99%

Factors for Sac Size Change of Abdominal Aortic Aneurysm after Endovascular Repair

Tsuyuki

Matsushita

Dohi

et al. 2014

ATCS

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Objectives: Factor(s) affecting the sac size of an abdominal aortic aneurysm (AAA) after endovascular aneurysm repair (EVAR) remain unclear. We compared the diameter of the aneurysm sac at one year after surgery with the preoperative diameter using CT images. Methods: Patients who underwent EVAR at Juntendo University Hospital were involved. According to the size change in treated lesions of the aorta, patients were categorized into the following 3 groups: shrink (<5 mm of reduction), enlarge (>5 mm of expansion), and no change (size change within 5 mm). The patients' background, laboratory data, devices used, medications, anatomical characteristics, and presence/absence of postoperative endoleaks were examined. Results: Of the 68 consecutive patients, 23 were excluded. Seventeen patients were classified into the shrink group, 28 patients into the no change group, and no patients into the enlarge group. Patients with higher thrombotic area rate on the preoperative AAA tended to present AAA sac shrinkage (p = 0.05). No other variables affected the size change in this study. In addition, the existence of an endoleak suggested the interference of sac shrinkage. Conclusions: The higher AAA thrombotic area rate tended to associate with AAA sac shrinkage.

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Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective

Abstract: Selective intervention to treat type II endoleak that persists for 6 months and is associated with aneurysm enlargement seems to be both safe and cost-effective. Longer follow-up will determine whether this conservative approach to management of type II endoleak is the standard of care.

Cited by 170 publications

References 43 publications

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Late Sac Behavior after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Factors for Sac Size Change of Abdominal Aortic Aneurysm after Endovascular Repair

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