Partial open conversion with proximal aortic banding and endograft preservation is a safe option for the treatment of persistent type II endoleaks

Staniszewski, Thomas; Beyer, Reagan; Matsumura, Jon S.; Morgan, Courtney E.

doi:10.1016/j.jvscit.2021.08.003

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Furthermore, our data confirm the technical feasibility of a surgical conversion as definitive treatment for refractory TIIEL and, in accordance with previous published experiences, suggest that semiconversion should be considered less invasive and as effective as endograft removal [ 17 , 26 ].…”

Section: Discussionsupporting

confidence: 90%

Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers

Sirignano

Mangialardi

Nespola

et al. 2022

JPM

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Introduction: The aim of the present study is to report the outcome of patients presenting an isolated type II endoleak (TIIEL) requiring reintervention and to identify clinical and anatomical characteristics potentially implicated in refractory TIIEL occurrence and fate. Materials and Methods: A multicenter retrospective study on TIIEL requiring reintervention was conducted between January 2003 and December 2020. Demographic and clinical characteristics, procedural technical aspects, reinterventions, and outcomes were recorded. TIIEL determining sac expansion greater than 10 mm underwent a further endovascular procedure aiming to exclude aneurismal sac. Redo endovascular procedures were performed via endoleak nidus direct embolization and/or aortic side branches occlusion. TIIELs responsible for persisting aneurysmal sac perfusion 6 months after redo endovascular procedures were classified as “refractory” and submitted to open conversion. Results: A total of 102 TIIEL requiring reintervention were included in the final analysis. Eighty-eight (86.27%) patients were male, the mean age was 77.32 ± 8.08 years, and in 72.55% of cases the American Society of Anaesthesiologists (ASA) class was ≥3. The mean aortic diameter was 64.7 ± 14.02 mm, half of treated patients had a patent inferior mesenteric artery (IMA), and 44.11% ≥ 3 couples of patent lumbar arteries (LA). In 49 cases (48.03%) standard endovascular aneurysm repair (EVAR) procedure was completed without adjunctive maneuvers. All enrolled patients were initially submitted to a further endovascular procedure once TIIEL requiring reintervention was diagnosed; 57 patients underwent LAs or IMA embolization (55.87%), 42 transarterial aneurismal sac embolization (41.17%), and three (2.96%) laparoscopic ostial ligations of the inferior mesenteric artery. During a mean follow-up of 15.22 ± 7.57 months (7–48), a redo endovascular approach was able to ensure complete sac exclusion in 52 cases, while 50 patients presented a still evident refractory TIIEL and therefore a surgical conversion or semiconversion was conducted. At the univariate analysis refractory TIIEL patients were significantly different from those who did not develop the complication in terms of preoperative clinical, morphological characteristics, and initial EVAR procedures: coronary artery disease occurrence (p = 0.005, OR: 3.18, CI95%: 1.3–7.2); preoperative abdominal aortic aneurysm (AAA) sac diameter (p = 0.0055); IMA patency (p = 0.016, OR: 2.64, CI95%: 1.18–5.90); three or more patent LAs; isolated standard EVAR without adjunctive procedures (p > 0.0001; OR: 9.48, CI95%: 3.84–23.4). Conclusions: Our experience seems to demonstrate that it is reasonable to try to preoperatively identify those patients who will develop a refractory TIIEL after EVAR and those with a TIIEL requiring reintervention for whom a simple endovascular redo will not be enough, needing surgical conversion.

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Section: Discussionsupporting

confidence: 90%

Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers

Sirignano

Mangialardi

Nespola

et al. 2022

JPM

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“…17,18) In addition, in cases of endograft preservation, the proximal neck banding method may be able to prevent aneurysm re-enlargement and neck enlargement-induced T1aEL. 19,33) Laparoscopic approaches without laparotomy may be effective only if the feeding arteries are ligated. A systematic review of laparoscopic ligation of the feeding arteries that cause T2EL demonstrated that it may be used as a potential alternative treatment method if standard endovascular embolization fails.…”

Section: Osc With Endograft Preservation (Semi-conversion Technique E...mentioning

confidence: 99%

Surgical Treatment of Sac Enlargement Due to Type II Endoleaks Following Endovascular Aneurysm Repair

Onitsuka

Ito

2023

Annals of Vascular Diseases

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An aneurysm sac enlargement caused by type II endoleak (T2EL) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms may cause serious complications such as rupture. Consequently, methods that preoperatively prevent or postoperatively treat T2EL have been employed. When significant aneurysm enlargement occurs due to persistent T2EL, embolization is first performed through several access points. However, although these endovascular reinterventions have a high technical success rate and are safe, their effectiveness remains questionable. When such endovascular procedures fail to stabilize sac enlargement, open surgical conversion (OSC) becomes the last-resort treatment option. We review several strategies of OSC for the repair of T2EL following EVAR. Among the three main OSC procedures, namely, complete endograft removal, partial endograft removal, and complete endograft preservation, partial endograft removal under infrarenal clamping was considered the most appropriate owing to its less invasiveness and durability.

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“…Of the two types of open aortic procedures requiring remedial secondary interventions, this type is a bit more frequent and less technically challenging. [3][4][5] Typically, these patients present many years after placement of an endograft and have had frequent and numerous interventions for aneurysm growth directed at occluding either the lumbar arteries or the inferior mesenteric artery. Table 1 describes the types of approaches.…”

Section: Exposure and Salvage Of Endograftmentioning

confidence: 99%

Explant of the Aortic Endograft: Today’s Solutions, Tomorrow’s Problems

Lumsden

2023

Methodist DeBakey Cardiovascular Journal

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Type 2 endoleaks remain the Achilles heel of abdominal aortic endografting. They drive imaging costs and repeat intervention. We believe that after two endovascular interventions, patients should be considered for either graft explantation or graft salvage through an open abdominal exploration. Graft explantation has been associated with increased morbidity and mortality but remains necessary in the face of non-correctible type 1a endoleaks, graft failure, or graft infection. In the majority of cases AAA expansion due to persistent type 2 endoleak is the culprit. In this situation, open repair, with oversewing of the lumbar or inferior mesenteric arteries, can be accomplished providing the seal zones and component overall zones are adequate. This approach does not require aortic clamping. We provide detailed descriptions and videos to facilitate the surgeon in performing these complex procedures.

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Partial open conversion with proximal aortic banding and endograft preservation is a safe option for the treatment of persistent type II endoleaks

Abstract: Partial open conversion with proximal aortic banding and endograft preservation is a safe option for the treatment of persistent type II endoleaks,

Cited by 5 publications

References 16 publications

Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers

Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers

Surgical Treatment of Sac Enlargement Due to Type II Endoleaks Following Endovascular Aneurysm Repair

Explant of the Aortic Endograft: Today’s Solutions, Tomorrow’s Problems

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