Influence of Treatment of Type II Leaks on the Aneurysm Surface Area

Abstract

only complete occlusion of endoleaks results in decrease in the size of the aneurysm sac. Because of endotension and the risk of rupture we favour an early interventional treatment of type II endoleaks.

Outcomes of type II endoleaks after endovascular abdominal aortic aneurysm (AAA) repair: a single-center, retrospective study

“…Incidence of type II endoleaks in prior studies has ranged from 3% to 43%, with an overall incidence in a recent systematic review of 10.2% [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The incidence in our study was much higher than this finding at 40.5% but fell within the range of previously reported incidence.…”

“…Type II endoleaks are the most common, occurring in 3-43% of patients who have undergone EVAR, and occur when blood flows retrograde into the aneurysm sac through branch vessels and anastomotic connections [9]. Although common, there is no consensus on the optimal management of type II endoleaks once discovered [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Most physicians advocate that type II endoleaks have a benign course and practice a conservative approach of serial monitoring with computed tomography angiography (CTA) or ultrasound [10][11][12][13][14][15][16][17][18][19][20][21].…”

“…Most physicians advocate that type II endoleaks have a benign course and practice a conservative approach of serial monitoring with computed tomography angiography (CTA) or ultrasound [10][11][12][13][14][15][16][17][18][19][20][21]. Other physicians believe that type II endoleaks lead to aneurysm sac rupture and practice a more aggressive approach of embolization of the endoleak [22][23][24][25][26].…”

Early Elective Conversion for Failing Evar

“…Compassionate proponents for EVAR have tried to repair failing endografts with numerous endovascular maintenance procedures in-stead of taking the risk of conversion to open surgery. When endovascular procedures have failed or are not possible, some patients have been left under mere observation (12)(13)(14)(15)(16).…”

Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association

“…Thus, embolization of a single feeding vessel does not provide a durable repair. A type II endoleak must be managed similar to the treatment of an arteriovenous malformation: either the nidus or all contributing branches must be occluded, as vessel recruitment is otherwise likely to occur, with resultant continued risk of aneurysm enlargement and possible rupture (214). Because of anatomic constraints, selective transarterial embolization cannot be used to occlude patent arterial branches in some cases and, in others, multiple patent branches can make this approach cumbersome and often ineffective in providing a durable repair (212,213).…”