Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes

Jones, John E.; Atkins, Marvin D.; Brewster, David C.; Chung, Tae Sub; Kwolek, Christopher J.; LaMuraglia, Glenn M.; Hodgman, Thomas M.; Cambria, Richard P.

doi:10.1016/j.jvs.2007.02.073

Cited by 388 publications

(317 citation statements)

References 36 publications

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“…9,17,18 Even when feeding patent vessels are not clearly present, but when there is evidence of sac enlargement, authors have shown concern about the risk of rupture and the evolution of sac dimensions.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] However, given the consistent percentage of stable or regressive type II endoleak, the need for treatment remains controversial. 4,6,9 According to the European Collaborators on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROSTAR) database, most type II endoleaks will thrombose spontaneously and have a benign course. 8 Treatment is considered only for large, high-flow endoleaks or in case of aneurysmal growth.…”

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confidence: 99%

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Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement

Mangialardi

Ronchey

Orrico

et al. 2015

Journal of Vascular Surgery

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Objective: The goal of this study was to present open surgical conversion with graft salvage or "semiconversion" as a definitive and safe treatment for untreatable and persistent type II endoleaks causing sac enlargement after endovascular aneurysm repair. Methods: Between January 2001 and December 2014, 25 of 1623 endovascular aortic repair (EVAR) patients were selected as candidates for open semiconversion. The indication was persistent type II endoleak in 13 patients (12 of whom received previous attempts of embolization), type I and II endoleak in 2 patients, and sac growth without imaging evidence of endoleak in the other 10. After the infrarenal aorta was prepared (via a retroperitoneal access, whenever possible), the technique consisted of performing a banding of the neck with Teflon (DuPont, Wilmington, Del), a sacotomy to remove the thrombus or the hygroma, or both, and then suturing all of the feeding vessels that were found. Proximal and distal fenestrations were performed to avoid sac repressurization. Results: The semiconversion was performed after a mean of 74 months after the initial EVAR. The mean aneurysm size at the time of the EVAR was 6.0 cm (range, 5.0-9.5 cm), and the mean aneurysm size at the time of the semiconversion was 7.7 cm (range, 5.5-11.5 cm). The overall aneurysm size increase was 38%, and the average growth rate was 8.2% per year. One patient had a stable aneurysm size but was treated because of an emergency condition. Technical success was 100%, with resolution of the endoleak and no perioperative deaths. Four cardiac deaths were registered at 12, 26, 30, and 60 months (mean follow-up, 42 months; range, 1-80 months). Conclusions: Graft salvage appears to be a valid option compared with open repair when considering treatment of persistent type II endoleak. This case series shows that semiconversion is a safe and effective treatment for otherwise untreatable type II endoleak. (J Vasc Surg 2015;62:1437-41.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement

Mangialardi

Ronchey

Orrico

et al. 2015

Journal of Vascular Surgery

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“…This constitutes a strong argument for selective preoperative endovascular intervention in view of the substantial risk of persistent type II endoleak. 23) To determine the indication of selective intervention of the IMA prior to EVAR, preoperative CT constitutes the most reliable and easily available image source. Univariate analysis of the anatomical variables of preoperative CT revealed that stenosis and thrombus of the IMA orifice is associated with both transient and permanent type II endoleak.…”

Section: Discussionmentioning

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

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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.

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“…Although most T2Es resolve spontaneously within a few months or remain benign, [9][10][11][12] persistent T2Es can be associated with sac expansion and, therefore, require secondary intervention 10 to avoid rupture. Currently, two major endovascular techniques exist for the management of T2Es: direct translumbar embolization (TLE) and transarterial embolization (TAE).…”

Section: Type II Endoleak Following Endovascular Repair Of Infrarenalmentioning

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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Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes

Cited by 388 publications

References 36 publications

Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement

Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement

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

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

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