Is a Type II Endoleak after EVAR a Harbinger of Risk? Causes and Outcome of Open Conversion and Aneurysm Rupture during Follow-up

Marrewijk, C.J. van; Fransen, Gerdine A. J.; Laheij, R.J.F.; Harris, Peter L.; Buth, Jacob; Collaborators, for the EUROSTAR

doi:10.1016/j.ejvs.2003.10.016

Cited by 288 publications

(205 citation statements)

References 40 publications

(36 reference statements)

Supporting

Mentioning

187

Contrasting

Unclassified

Order By: Relevance

“…This study end point has been used in other published reports, 20,21 and has been associated with an increased risk of adverse outcomes, including the need for subsequent open repair and aneurysm rupture. 22,23 The natural history of untreated aneurysms is to enlarge over time until eventual rupture. Endovascular repair aims to prevent aortic rupture; thus, AAA sac enlargement represents treatment failure, because it leaves the patient at risk of death resulting from rupture.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair

et al. 2011

View full text Add to dashboard Cite

Background-The majority of infrarenal abdominal aortic aneurysm (AAA) repairs in the United States are performed with endovascular methods. Baseline aortoiliac arterial anatomic characteristics are fundamental criteria for appropriate patient selection for endovascular aortic repair (EVAR) and key determinants of long-term success. We evaluated compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement. Methods and Results-Patients with pre-EVAR and at least 1 post-EVAR computed tomography scan were identified from the M2S, Inc. imaging database (1999 to 2008). Preoperative baseline aortoiliac anatomic characteristics were reviewed for each patient. Data relating to the specific AAA endovascular device implanted were not available. Therefore, morphological measurements were compared with the most liberal and the most conservative published anatomic guidelines as stated in each manufacturer's instructions for use. The primary study outcome was post-EVAR AAA sac enlargement (Ͼ5-mm diameter increase). In 10 228 patients undergoing EVAR, 59% had a maximum AAA diameter below the 55-mm threshold at which intervention is recommended over surveillance. Only 42% of patients had anatomy that met the most conservative definition of device instructions for use; 69% met the most liberal definition of device instructions for use. The 5-year post-EVAR rate of AAA sac enlargement was 41%. Independent predictors of AAA sac enlargement included endoleak, age Ն80 years, aortic neck diameter Ն28 mm, aortic neck angle Ͼ60°, and common iliac artery diameter Ͼ20 mm. Conclusion-In this multicenter observational study, compliance with EVAR device guidelines was low and post-EVAR aneurysm sac enlargement was high, raising concern for long-term risk of aneurysm rupture. (Circulation. 2011;123:2848-2855.)

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair

et al. 2011

View full text Add to dashboard Cite

show abstract

“…3) Persistent type II endoleak has been associated with a higher incidence of adverse outcomes, including aneurysmal sac growth, need for reintervention and for conversion to open repair, and rupture. 4,5) The most commonly involved branches are the inferior mesenteric artery (IMA) and lumbar arteries (LA), which are usually covered with endografts. Various strategies have been advocated for managing persistent type II endoleak with some investigators recommending preemptive adjunctive procedures such as IMA coil embolization to preclude type II endoleak.…”

Section: Introductionmentioning

confidence: 99%

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

Fukuda

Matsuda

Sanda

et al. 2014

Annals of Vascular Diseases

View full text Add to dashboard Cite

Purpose:To identify the computed tomography (CT) findings of persistent type II endoleak from the inferior mesenteric artery (IMA) which indicate the need for preoperative IMA embolization. Materials and Methods: Included were 120 patients (96 males, 49-93 years old, mean: 77.7) who underwent endovascular aortic aneurysm repair (EVAR) between June 2007 and October 2010. The relationship between persistent type II endoleak and CT findings of IMA orifice was examined. Results: CT showed no type II endoleak from IMA in 106 patients (89%; Group N), and transient type II endoleak from IMA in 10 patients (8.3%; Group T). CT showed persistent type II endoleak from IMA in 4 patients (3.3%; Group P) and three of them underwent reintervention. Univariate Cox-Mantel test analysis indicated that stenosis (p = 0.0003) and thrombus (p = 0.043) in IMA orifice were significant factors for persistent type II endoleak. The ratios of patients with proximal IMA more than 2.5 mm diameter in Groups N, Y, and P were 26/106 (24%), 5/10 (50%) and 4/4 (100%), respectively. Conclusion: Indicators for embolization of IMA prior to EVAR for the prevention of type II endoleak appear to be: (1) more than 2.5 mm in diameter and (2) no stenosis due to calcification or mural thrombus in IMA orifice.

show abstract

“…Marrewijk et al similarly claimed that T2Ls are not benign, and suggested that aneurysm expansion >8 mm is an indication for reintervention [17]. A retrospective analysis of 700 patients undergoing EVAR also demonstrated how T2Ls may not always have a benign course [18].…”

Section: Journal Of Vascular and Endovascular Surgery Issn 2573-4482mentioning

confidence: 97%

The Natural History of Type 2 Endoleaks after EVAR Justifies Conservative Management

Ajalata¹,

Williamsa²,

Wilsona³

2017

J Vasc Endovasc Surg

View full text Add to dashboard Cite

Objective: Management of type 2 endoleaks (T2Ls) after endovascular aneurysm repair (EVAR) has been controversial. Some advocate for conservative management, while others believe that intervention is indicated. This study investigated the natural history of T2Ls in order to derive direction in management. Methods:Patients who had EVAR at the Long Beach VA were retrospectively identified and computerized tomographic angiography (CTA) was independently reviewed by a radiologist and a vascular surgeon. T2Ls were analyzed for the following outcomes: rupture, duration of endoleak, spontaneous resolution, changes in the size of the aneurysm sac, and reintervention rates. Results:Of the 160 patients who had completed required followup to date (mean 3 years) after EVAR, 39 patients (24.4%) were identified as having a T2L on CTA imaging. 6 of these 39 patients (15.4%) required repair due to aneurysm sac growth >1 cm. Two (5.13%) were repaired with an open procedure and 4 (10.3%) with an endovascular approach. Of these 6 aneurysm leaks requiring repair, 4 (66.7%) had a simultaneous endoleak (types 1 or 3) in addition to the identified T2L. Spontaneous resolution of T2Ls occurred in 16 (41.0%) patients. Conclusions:Overall, we found that 85% of patients who had T2Ls did not require intervention after a mean follow up time of 3 years. The association of a type 1 or 3 endoleak with a T2L was more likely to require correction due to aneurysm expansion >1 cm, thus T2Ls associated with another type of endoleak require more aggressive management.

show abstract

Is a Type II Endoleak after EVAR a Harbinger of Risk? Causes and Outcome of Open Conversion and Aneurysm Rupture during Follow-up

Cited by 288 publications

References 40 publications

Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair

Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair

CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

The Natural History of Type 2 Endoleaks after EVAR Justifies Conservative Management

Contact Info

Product

Resources

About