Natural History, Diagnosis, and Management of Type II Endoleaks after Endovascular Aortic Repair: Review and Update

D’Oria, Mario; Mastrorilli, Davide; Ziani, Barbara

doi:10.1016/j.avsg.2019.04.048

Cited by 34 publications

(16 citation statements)

References 159 publications

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“…19 Although data in the literature are scarce to assess the long-term clinical relevance of these type 2 endoleaks, some might actually lead to aneurysm sac expansion as also shown in this study, alike to what can be observed after standard or fenestrated-branched EVAR. 20,21 Furthermore, one should consider that embolization of hypogastric side branches when a stent-graft has already been deployed across a hypogastric aneurysm would be an extremely challenging (if not unfeasible) procedure. Therefore, it might be a better option to embolize those branches when it is relatively straightforward at the time of first intervention.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

et al. 2021

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Objective To evaluate early and follow-up outcomes following bilateral use of iliac branch devices (IBD) for aortoiliac endografting and assess the impact of center volume. We used data from the pELVIS international multicentric registry. Methods For the purpose of this study, only those patients receiving concomitant bilateral IBD implantation were analyzed. To assess the impact that procedural volume of bilateral IBD implantation could have on early and follow-up outcomes, participating institutions were classified as Site(s) A if they had performed >10 and/or >20% concomitant bilateral IBD procedure, otherwise they were classified as Site(s) B. Endpoints of the analysis included early (ie, 30-day) mortality and morbidity, as well as all-cause and aneurysm-related mortality during follow-up. Additional endpoints that were evaluated included IBD-related reinterventions, IBD occlusion or stenosis requiring reintervention (ie, loss of primary patency), and IBD-related type I endoleak. Results Overall, 96 patients received bilateral IBD implantation (out of 910 procedures collected in the whole pELVIS cohort), of whom 65 were treated at Site A (ie, Group A) and 31 were treated at Site(s) B (ie, Group B). In total, only 1 death occurred within 30 days from bilateral IBD implantation, and 9 patients experienced at least 1 major complication without any significant difference between subjects in Group A versus those in Group B (10.8% vs 6.5%, p=0.714). In the overall cohort, the 2-year freedom from IBD-related type I endoleaks and IBD primary patency were 96% and 92%, respectively; no significant differences were seen in those rates between Group A or Group B (95% vs 100%, p=0.335; 93% vs 88%, p=0.470). Freedom from any IBD-related reinterventions was 83% at 2 years, with similar rates between study groups (85% vs 83%, p=0.904). Conclusions Within the pELVIS registry, concomitant bilateral IBD implantation is a safe and feasible technique for management of aortoiliac aneurysms in patients with suitable anatomy. Despite increased technical complexity, effectiveness of the repair is satisfactory with low rates of IBD-related adverse events at mid-term follow-up. Procedural volume does not seem to affect technical or clinical outcomes after bilateral use of IBD, which remains a favorable treatment option in selected patients.

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Section: Discussionmentioning

confidence: 99%

Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

et al. 2021

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“…These results are rather disappointing as failure to aneurysm sac regression after EVAR is associated with higher long-term mortality (33); however the presented results match with those found by other authors: Azafra et al (14). Therefore, long-term follow-up after T2EL embolisation seems mandatory (34). Both pre-interventional imaging and clinical parameters for higher risk of persistent aneurysm sac expansion after T2EL embolisation were analysed, showing unsharp or 'blurred' delineation of the nidus of the T2EL to be predictive of persistent T2El after embolisation (p=0.025).…”

Section: Discussionmentioning

confidence: 99%

Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up

Vandenbulcke¹,

Houthoofd²,

Laenen³

et al. 2023

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“…Current guidelines suggest that a conservative approach is appropriate for isolated type II endoleaks without sac expansion [24,25]. Intervention is recommended when there is a sac enlargement of more than 10 mm [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…In this series, most type II endoleaks resolved spontaneously, and only 3 patients required intervention. Nevertheless, secondary interventions for type II endoleaks are often unsatisfactory as recurrence is common, and long-term follow-up is also mandatory [24,25].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan

Janho

Rashaideh

Shishani

et al. 2019

VSI

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PurposeThe outcomes of endovascular aneurysmal repair (EVAR) for infrarenal abdominal aortic aneurysms (AAAs) in the Middle East have rarely been reported. We analyzed the outcomes of EVAR in a Jordanian population.Materials and MethodsWe conducted a retrospective review of the medical records of patients with infrarenal AAA who were treated with elective EVAR between January 2004 and January 2017 at a single center in Jordan. Patient characteristics, anatomical characteristics, procedural details, and early and late postoperative outcomes were analyzed.ResultsA total of 288 patients (mean age, 70 years; 77.8% males) underwent EVAR for infrarenal AAA (median aneurysm size, 64 mm). Bifurcated endografts were used in 265 patients, and aorto-uni-iliac devices were used in 22 patients. Successful endograft deployment was achieved in all patients with no open conversion. Early complications included localized groin hematoma in 15, femoral artery dissection in 4, wound infection in 3, and seroma in 3 patients. With a mean follow-up of 60 months, 50 endoleaks were detected, including 9 type I, 38 type II, and 3 type III. Seven patients had unilateral graft limb occlusion. The 30-day mortality was 1.7%, and long-term mortality was 7.0%, mostly due to non-AAA-related causes.ConclusionEVAR was safely performed in Jordanian patients with minimal complications. However, long-term surveillance is important due to the risk of endoleaks and consequent intervention.

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Natural History, Diagnosis, and Management of Type II Endoleaks after Endovascular Aortic Repair: Review and Update

Cited by 34 publications

References 159 publications

Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up

Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan

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