Mid-term Outcomes and Predictors of Transarterial Embolization for Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

Abstract

To evaluate the mid-term outcomes of transarterial embolization (TAE) for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR) and investigate the predictors of sac enlargement after embolization. Materials and Methods:We conducted a retrospective analysis of 55 patients (48 men and 7 women, median age 79.0 (interquartile ranges 74-82) years) who underwent TAE for type II endoleak from 2010 to 2018. The aneurysmal sac enlargement, endoleaks, aneurysm-related adverse event rate, and reintervention rate were evaluated.Patients' characteristics and clinical factors were evaluated for their association with sac enlargement. Results:Fifty-five patients underwent TAE with technical success and were subsequently followed for a median of 636 (interquartile ranges 446-1292) days. The freedom from sac enlargement rates at 1, 3, and 5 years were 73.2%, 32.0%, and 26.7%, respectively. After initial TAE, the recurrent type II, delayed type I and occult type III endoleak were identified in 39 (71%), 5 (9%) and 3 (5%) patients, respectively. Although a patient had aorto-duodenal fistula, there was no aneurysm-related death. The freedom from reintervention rates were 84.6%, 35.7%, and 17.0%, respectively. In the multivariate analysis, sac diameter >55 mm at initial TAE (hazard ratios, 3.23; 95% confidence intervals, 1.22-8.58; P <0.05) was a significant predictor of sac 3 enlargement. Conclusion:TAE for type II endoleak was not effective in preventing sac enlargement, and reinterventions were required among the mid-term follow-up. The sac diameter >55 mm at initial TAE was a significant predictor of sac enlargement.

Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer

“…The embolization results published for NBCA without/with coils in T2ELs [21][22][23]44] tend to be inferior to the EVOH data. Horinouchi et al currently report clinical success rates with NBCH and coils of 73 % and 32 % after 1 or 3 years, respectively [22].…”

“…There are two established ways of accessing the endoleak cavity: transarterial catheterization with a microcatheter and percutaneous direct puncture of the aneurysm sac. Performing T2EL coil embolization alone is often ineffective due to the high recanalization rates [20][21][22]. The liquid embolic agents used most frequently in T2ELs are N-butylcyanoacrylate (NBCA) and ethylene vinyl alcohol copolymer (EVOH).…”

Recent Update of Endovascular Type 2 Endoleak Management

“…Fujimura et al [23] reported that transarterial embolization of isolated T2ELs with sac expansion using a triaxial system resulted in only a 12.5% resolution of T2ELs at 16 months. Neither of the two reports [23,43] was satisfactory in terms of the outcome of reintervention for T2ELs.…”

“…Two reports in East-Asian populations from Japan [23,43] also mentioned a high probability of sac diameter enlargement after treatment for T2ELs. Horinouchi et al [43] suggested that transcatheter arterial embolization for T2ELs should be performed before the sac enlarges to > 10 mm, although this protocol differs from the ESVS guideline recommendations, because the progress of sac diameter enlargement after treatment for T2ELs was significantly associated with a sac diameter of ! 55 mm at the time of the initial intervention for T2ELs.…”

“…With respect to the transarterial approach, transarterial embolization for T2ELs using a triaxial system in an East-Asian population was reported from Japan [23,43]; however, the technical and clinical success rates were not satisfactory.…”