A systematic review of treatment modalities and outcomes of type Ib endoleak after endovascular abdominal aneurysm repair

Abstract

Objectives To collect specific literature on type Ib endoleak after aorto-iliac endografting for abdominal aortic aneurysm, reporting data on diagnosis, treatment, and follow-up results. Methods Publications about type Ib endoleak after aorto-iliac endografting for abdominal aortic or iliac aneurysm were searched in PubMed, Web of Science, and Scopus. Considered studies were in English and published until 3 November 2016. Research methods and reporting were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Inclusion criteria were: (1) reporting on abdominal aortic or iliac aneurysm as primary diagnosis; (2) reporting on distal endoleak after aorto-iliac endografting. Patient data, data on endovascular treatment, endoleak, reintervention, and follow-up were collected by two independent authors. Results Included studies were 11 (five original articles, six case reports), corresponding to 29 patients and 30 type Ib endoleak. Excluding missing data (2/30, 6.7%), type Ib endoleak was treated intra-operatively, within six months and after six months in six cases (21.4%), eight cases (28.6%), and fourteen cases (50%), respectively. Treatment of type Ib endoleak was endovascular in 27 cases (90%) (7 embolizations + extender cuffs, 10 extender cuffs, 8 embolizations without extender cuff, 1 Palmaz stenting and 1 iliac branched endograft), hybrid in 1 case (3.3%) and surgical in 2 cases (6.6%). Buttock claudication occurred in two cases (6.7%). One-month mortality was 3.4% (2/29) without events due to type Ib endoleak. In 14 cases (46.7%), median follow-up was six months (interquartile range: 2.75-14; range: 0.75-53). Type Ib endoleak persisted or reappeared in three cases (10%), all after endovascular treatment. Two of these (2/3, 66.7%) needed endovascular reintervention. No death during follow-up was reported. Conclusions Few specific data are available in literature about type Ib endoleak after aorto-iliac endografting for abdominal aortic aneurysm. About 50% of type Ib endoleak occurred after six months from the endovascular abdominal aneurysm repair procedure. Treatment is mainly endovascular and distal endograft extension is the main and effective treatment. Buttock claudication is the most frequent complication in case of exclusion of internal iliac artery. Persistent type Ib endoleak is possible, and adjunctive endovascular procedures are necessary.

Evolving Concepts, Management, and Treatment of Type 1 Endoleaks after Endovascular Aneurysm Repair

“…Over 50% of T1b endoleaks occur within 6 months of the index operation for an EVAR. 9 Recent studies have outlined that both landing zones and iliac arteries are subjected to the outward radial force of the graft, potentially leading to T1b endoleaks. 9,26,27 The rate of iliac artery expansion/remodeling is greatest in the first 6 months at nearly a rate of 1 mm/month.…”

“…9 Recent studies have outlined that both landing zones and iliac arteries are subjected to the outward radial force of the graft, potentially leading to T1b endoleaks. 9,26,27 The rate of iliac artery expansion/remodeling is greatest in the first 6 months at nearly a rate of 1 mm/month. 26 Similar to T1a endoleaks, the exact physiology for iliac artery remodeling is not well understood and primarily relies on in vitro studies.…”

“…Large common iliac arteries (> 16 mm) 9 Short iliac sealing zone (< 10 mm) 9 Tortuosity of iliac axes 27 Aneurysm sac > 65 mm in diameter 9 Iliac endografts with a diameter > 24 mm 9 Large common iliac arteries (> 16 mm) This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.…”

“…5 years. 9,29 Only the length of initial iliac limb seal achieved during the initial operation is protective.…”

“…Limb extension into the external iliac artery without embolization of the internal iliac is not advised, as the resultant T2 endoleak may lead to the expansion of the iliac artery and adverse remodeling. 9 Reappearance of the endoleak following extension and embolization may occur in 10% of cases. Unilateral internal iliac artery embolization is usually well tolerated; the greatest morbidity is buttock claudication for the patient which was reported in 6.7% of the cases.…”