Type II endoleaks: diagnosis and treatment algorithm

Abstract

Elective abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm, symptomatic, or rapidly expanding more than 0.5 cm in 6 months. Seventy-five percent of AAAs today are treated with endovascular aneurysm repair (EVAR) rather than open repair. This is fostered by the lower periprocedural mortality, complications, and length of hospital stay associated with EVAR. However, some studies have demonstrated EVAR to result in higher reintervention rates than with open repair, largely due to endoleaks. Type II is the most common, making up 10-25% of all endoleaks. Type II endoleaks, can potentially enlarge and pressurize the aneurysm sac with a risk of rupture. However, many type II endoleaks spontaneously resolve or never lead to sac enlargement. Imaging surveillance and approaches to management of type II endoleaks are reviewed here.

Type II Endoleaks After EVAR: A Literature Review of Current Concepts

“…15 The most common arteries causing TIIEL are the lumbar and inferior mesenteric artery (IMA), and less commonly, the internal iliac artery (IIA), sacral artery, or accessory renal arteries. 9 Type II endoleak can be divided into 2 main categories depending on the number of arteries feeding the aneurysmal sac. In type IIa, there is a single causative vessel feeding the aneurysm sac.…”

“…In type IIb, there are multiple vessels involved, behaving similar to an arteriovenous malformation, the latter being more challenging to treat than the former. 9 This type of endoleak can occur within 30 days, 6 months, or after a year of EVAR, denominated early, persistent, or late, respectively. 13 The rate is generally higher at the first phases occurring in around 15% of the patients, and only a few TIIEL are identified at a late phase, with prevalence gradually decreasing to <10% at 2 years.…”

A Late Post-EVAR Rupture in a 102-Year-Old Patient Related to a Type II Endoleak

“…Elective endovascular abdominal aortic aneurysm repair (EVAR) is recommended for most patients with suitable anatomy and reasonable life expectancy as the preferred treatment modality. 1 The European Society for Vascular Surgery guidelines suggested a pragmatic definition of reasonable life expectancy being >2 to 3 years and <10 to 15 years. 2 Seventy-five percent of patients requiring elective abdominal aortic aneurysm (AAA) repair are treated by an endovascular approach related to a decreased early mortality, complications, and length of hospital stay, compared to open repair.…”

“…2 Seventy-five percent of patients requiring elective abdominal aortic aneurysm (AAA) repair are treated by an endovascular approach related to a decreased early mortality, complications, and length of hospital stay, compared to open repair. 1,3 The US Census estimates the >85 years group will more than triple in size over the next decades. 4 The prevalence of AAAs increases with age.…”

Sac Embolization and Side Branch Embolization for Preventing Type II Endoleaks After Endovascular Aneurysm Repair: A Meta-analysis

“…3 Treatment of an EII includes embolization of the IMA or lumbar arteries with coils or glue, direct translumbar injection of the aneurysm sac, transcaval embolization, or laparoscopic ligation of the IMA and lumbar arteries. 4 However, these interventions are not always successful, and some sacs continue to expand despite repeated reinterventions. 5 Thus, effective treatment of EIIs remains challenging.…”