Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion

Aziz, Abdulhameed; Menias, Christine O.; Sánchez, Luis A.; Picus, Daniel; Saad, Nael; Rubin, Brian G.; Curci, John A.; Geraghty, Patrick J.

doi:10.1016/j.jvs.2011.10.131

Cited by 109 publications

(83 citation statements)

References 22 publications

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“…Despite of the technique using for treatment of type II endoleaks, patients frequently need to undergo repeat interventions. [16][17][18][19][20] Especially, 51% of patients who were treated by only coil embolization have to endure second interventions. 20) Higher incidences of additional subsequent embolizations are reported for those who underwent these second interventions.…”

Section: Discussionmentioning

confidence: 99%

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Yamada

Takahashi

Tauchi

et al. 2015

Annals of Vascular Diseases

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Purposes: Endovascular abdominal aortic aneurysm repair (EVAR) is an increasingly used method of repairing abdominal aortic aneurysm (AAA). However, the treatment of persistent type II endoleak is still a controversial issue. Five cases are reported here in which we performed open surgical repair of growing aneurysm due to persistent type II endoleak. Method: Totally 128 EVAR cases were retrospectively reviewed, which were operated in our hospital from April 2008 to October 2013. These cases were followed by periodical contrast-enhanced computed tomography (CT) after EVAR. When persistent type II endoleak caused aneurysm sac growth, we performed surgical repair method for the first line treatment. In the operation, we incised the aneurysm sac by abdominal small median incision approach and sutured lumber arteries from inside of aneurysm sac and tied inferior mesenteric artery (IMA) in addition to aneurysmorrhaphy. Contrast-enhanced CT scanning was performed in a week after open repair for the confirmation of complete treatment. Results: Five of 128 cases (3.9%) were needed to be surgically repaired because of aneurysm sac growth (>5 mm), including two ruptured AAA cases. All patients recovered uneventfully. Contrast-enhanced CT scanning performed a week after these operations showed no endoleak and intact stent grafts and reduction of the aneurysm size. Conclusion:We believe open surgical repair method of persistent type II endoleak with aneurysm expansion is secure method, and can be one of the preferable options for this life threatening complication after EVAR.Keywords: EVAR, AAA, type II endoleak, surgical repair less invasive method of abdominal aortic aneurysm (AAA) repair continues to gain popularity. Studies that compared the outcome of EVAR with open graft replacement have consistently demonstrated a significant reduction in morbidity with endovascular repair. [1][2][3][4] However, new type complications have plagued the stent graft approach, and importantly the failure to totally exclude the AAA by persistent perfusion and pressurization, defined as endoleak is one of the adverse outcomes. 5,6) Despite consensus on the treatment of type I and type III endoleak, controversy remains about the optimal strategy for the treatment of type II endoleak because each strategy has their own advantages and disadvantages. Although previous studies have shown that most type II endoleaks are benign and are rarely associated with adverse of events, 7) there are increasing reports of expanding aneurysm in the presence of type II endoleak eventually leading to aneurysm rupture. 8,9) A variety of treatment or prevention methods have been advocated. These days, the most popular approach for the treatment of type II endoleak is transarterial coil embolization or translumber embolization. Transarterial or translumber embolization often needs second interventions and close surveillances. In addition, intervention to treat endoleaks also has some risks of complications. In this point, there is a question if these methods are ...

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Section: Discussionmentioning

confidence: 99%

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Yamada

Takahashi

Tauchi

et al. 2015

Annals of Vascular Diseases

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“…The endoleak nidus is then embolized with liquid agents or coils, similar to TAE. 17 Repeat interventions are required in an estimated 2-20% of cases regardless of whether TAE or TLE was used, 8,16,32,33 usually because the culprit vessels were not adequately identified or treated during the initial embolization. This statistic underscores the importance of complete obliteration of the nidus of the endoleak.…”

Section: Discussion Natural History Risk Factors and Surveillance Ofmentioning

confidence: 99%

Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

Jan¹,

Mewissen²

2015

Journal of Patient-Centered Research and Reviews

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Journal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations. Recommended CitationJan MF, Mewissen MW. Type II endoleak following endovascular repair of infrarenal abdominal aortic aneurysm: innovative transgraft approach to contemporary management. J Patient-Centered Res Rev. 2015;2:118-126.

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“…Esta ha sido siempre objeto de controversia, con opiniones que abogan por tratar de forma agresiva casi todas las EF2 31 frente a otras más conservadoras que solo tratan crecimientos de saco superiores al centímetro 8 . En cualquier caso, es evidente que ofrece resultados pobres en su variante endovascular (embolización transarterial o translumbar) 6,7 o bien obliga a la reintervención abierta, perdiendo los beneficios del EVAR. Nuestra tasa de éxito del 63,6% en el tratamiento así lo confirma, e incide en la necesidad de estratificar el riesgo dentro de las EF2 y mejorar la selección de pacientes 32 .…”

Section: Discusión Y Conclusionesunclassified

“…Si bien las endofugas tipo 1 y 3 tienen un potencial mayor de ocasionar rotura del aneurisma 2 , es la endofuga tipo 2 (EF2) la más común ---con frecuencias que oscilan entre un 13 3 y un 44% 4 ---, la de diagnóstico más complicado 5 y, en caso de precisarse, la que presenta un tratamiento con resultados menos efectivos 6,7 .…”

Section: Introducción Y Objetivosunclassified

Endofugas tipo 2 en una población tratada con endoprótesis Gore® Excluder: incidencia, persistencia y crecimiento del saco aneurismático

et al. 2015

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Recibido el 5 de marzo de 2014; aceptado el 20 de enero de 2015 Disponible en Internet el 26 de febrero de 2015 PALABRAS CLAVEEndofuga; Procedimientos endovasculares; Aneurisma de aorta abdominal (MeSH); Crecimiento del saco aneurismático ResumenIntroducción: La endofuga tipo 2 (EF2) es la complicación más frecuente tras EVAR, con una tasa de crecimiento del saco variable y un tratamiento de resultados poco efectivos. Se pretende analizar la incidencia de EF2, su persistencia y evolución en una población homogénea, buscando variables predictoras de crecimiento del saco. Material y métodos: Setenta EF2 (32,2%) detectadas en 217 EVAR aortoilíacos tratados con GORE ® Excluder entre 2003 y 2011. Seguimiento clínico y con angiotomografía computarizada (media 32,5 meses). Análisis univariante de datos recogidos de forma prospectiva. Función de supervivencia de Kaplan-Meier y regresión de Cox. Resultados: Un 90% de varones con edad media 75,5 ± 8 años y diámetro aórtico 59,6 ± 10 mm. El vaso aferente más frecuente fue una arteria lumbar (n = 42), con un 30% de endofugas complejas (n = 21). Veinticinco endofugas fueron transitorias (35,7%) y 45 persistentes, grupo este último con mayor número de mujeres (p = 0,044) y de colaterales aferentes al saco (1,5 ± 0,7 vs. 1,2 ± 0,4, p = 0,022). Crecimiento > 5 mm en un 38,6% de casos (mediana 8,5 mm, rango 5-24); once se trataron con embolización (éxito 63,6%). Las endofugas complejas no incrementaron el riesgo. El único predictor independiente de crecimiento en la regresión de Cox fue la edad (HR 2,71 IC 95% 1,01-7,19 p = 0,046). Conclusiones: Las EF2 constituyen una complicación frecuente y sin factores predictores sóli-dos que permitan estratificar el riesgo de crecimiento del saco, por lo que es necesario un seguimiento exhaustivo.

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Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion

Cited by 109 publications

References 22 publications

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

Endofugas tipo 2 en una población tratada con endoprótesis Gore® Excluder: incidencia, persistencia y crecimiento del saco aneurismático

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