CT Features of Early Type II Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms Help Predict Aneurysm Sac Enlargement

Abstract

The strongest indicators for aneurysm sac enlargement are complex IMA-LA type II endoleak and the diameter of the largest feeding and/or draining artery.

Comparison of Computed Tomography Angiography (CTA) Findings in Post-Endovascular Aortic Aneurysm Repair CTA between Persistent and Transient Type II Endoleak

“…However, the difference between two groups was not statistically significant. This result is not directly comparable to that reported by Muller-Wille R, et al 8 because they used a different method of outcome measurement. Muller-Wille R, et al 8 classified simple and complex type II endoleak into four subtypes, and they found complex IMA-LA subtype to be significantly associated with aneurysmal sac enlargement (OR: 20.8, 95% CI: 4.9-88.9; p<0.001).…”

“…This result is not directly comparable to that reported by Muller-Wille R, et al 8 because they used a different method of outcome measurement. Muller-Wille R, et al 8 classified simple and complex type II endoleak into four subtypes, and they found complex IMA-LA subtype to be significantly associated with aneurysmal sac enlargement (OR: 20.8, 95% CI: 4.9-88.9; p<0.001). Number of feeder arteries showed a significantly greater proportion of 2 or less arterial feeders in the transient group (91.7%) than in the persistent group (52.6%); p = 0.012.…”

“…Regarding sources of type II endoleak, we found a significantly greater proportion of inferior mesenteric artery feeder in the persistent group (68.4%) than in the transient group (33.3%). According to a study by Muller-Wille R, et al 8 (despite this result being not directly comparable due to differences in outcome measurement between studies), presence of inferior mesenteric artery as a feeder artery was shown to be more frequent in the aneurysm enlargement group than in the non-enlargement group.…”

“…In addition to demographic and patient characteristics that have been discussed and reported in previous studies as predictors of persistent type II endoleak4, several other studies examined preprocedural imaging findings to identify factors that predict this particular variety of endoleak. [5][6][7][8][9] The objective of this study was to identify the relation of computed tomography angiography (CTA) findings in first post-EVAR CTA between transient and persistent type II endoleaks.…”

CT Boost, an Important Step in Endoleak Diagnosis

“…The clinical importance and need for intervention in early type II endoleaks is somewhat controversial, as nearly half of these will resolve spontaneously within 6 months, whereas some will become persistent and may result in further enlargement of the aneurysm (4À6). In a retrospective study performed by Muller-Wille et al, the authors concluded that the strongest predictor for aneurysm sac enlargement in type II endoleaks was the presence of complex inferior mesenteric artery or lumbar artery endoleaks, defined as multiple inflow and/or outflow vessels (7).…”