Risk Analysis of Aneurysm Sac Enlargement Caused by Type II Endoleak after Endovascular Aortic Repair

Ide, T.; Masada, Kazuhiro; Kuratani, Toru; Sakaniwa, Ryoto; Shimamura, Kazuo; Kin, Keiwa; Watanabe, Yoshiki; Matsumoto, Ryota; Sawa, Yoshiki

doi:10.1016/j.avsg.2021.06.013

Cited by 14 publications

(12 citation statements)

References 28 publications

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“…In their experience, the “at risk” group had a higher likelihood of both TIIEL and TIIEL related reinterventions [ 20 ]. In a more recent experience, Ide and coworkers revealed that chronic kidney disease stage ≥ 4, patent IMA, and a number of patent LAs were risk factors of aneurysm sac enlargement caused by TIIEL, essentially confirming the previous reported results [ 21 ]. Additionally, the present series seems to confirm this hypothesis except for the role of chronic kidney disease that was not observed in our patients, while CAD was significantly associated with differences in outcome.…”

Section: Discussionsupporting

confidence: 78%

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: 78%

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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“…Previously, a retrospective risk analysis of 320 patients showed that the IMA played a particular significant role in aneurysm-sac enlargement with type-II EL following EVAR. 10 The hazard ratio of IMA patency for sac enlargement was about 18, which was higher than that of other factors associated with aneurysm-sac enlargement, such as the number of patent LAs and chronic kidney disease ≥stage 4. A retrospective risk analysis of 490 patients showed the significant association between patent IMA and reintervention.…”

Section: Discussionmentioning

confidence: 79%

Impact of the Patency of Inferior Mesenteric Artery on 7-Year Outcomes After Endovascular Aneurysm Repair

et al. 2022

Self Cite

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Purpose:The impact of the preoperative patent inferior mesenteric artery (IMA) on late outcomes following endovascular aneurysm repair (EVAR) remains unclear. This study aimed to investigate the specific influence of IMA patency on 7-year outcomes after EVAR. Materials and Methods:In this retrospective cohort study, 556 EVARs performed for true abdominal aortic aneurysm cases between January 2006 and December 2019 at our institution were reviewed. EVARs performed using a commercially available device with no type-I or type-III endoleak (EL) during follow-up and with follow-up ≥12 months were included. A total of 336 patients were enrolled in this study. The cohort was divided into the patent IMA group and occluded IMA group according to preoperative IMA status. The late outcomes, including aneurysm sac enlargement, 2 reintervention, and mortality rates were compared between both groups using propensity-score matched data. Results:After propensity-score-matching, 86 patients were included in each group. The median follow-up period was 56 months (interquartile range: 32-94 months). The incidence of type-II EL at discharge was 50% in the patent IMA group and 19% in the occluded IMA group (p<0.001). The type-II EL from the IMA and the lumbar arteries was significantly higher in the patent IMA group than in the occluded IMA group (p<0.001 and p=0.002). The rate of freedom from aneurysm-sac enlargement with type-II EL was significantly higher in the occluded IMA group than in the patent IMA group (94% vs. 69% at 7 years; p<0.001). The rate of freedom from reintervention was significantly higher in the occluded IMA group than in the patent IMA group (90% vs. 74% at 7 years; p=0.007). Abdominal aortic aneurysm-related death and all-cause mortality did not significantly differ between groups (p=0.32 and p=0.34).Conclusions: IMA patency could affect late reintervention and aneurysm sac enlargement but did not have a significant impact on mortality. Preoperative assessment 3 and embolization of the IMA might be an important factor for improvement in late EVAR outcomes.

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“…Smoking is considered important risk factor for the occurrence and development of AAA, and smoking cessation can effectively reduce the AAA rupture rate by 20% 22 . Meanwhile, smoking can also prompt the occurrence of T2EL, as identified by the aforementioned largest prospective study 21 , recent meta-analyses 10,23 , and other retrospective studies 16,24 . Thus, patients with T2EL-related risk factor should be considered when implementing pre-embolism treatment during primary EVAR intervention.…”

Section: Discussionmentioning

confidence: 99%

“…The number of patent lumbar arteries is another risk factor for re-intervention. Recent studies 16,24,26 stated that a higher number of patent lumbar arteries, ranging from four to six, may increase the incidence of T2EL. In our study, the results of univariate and multivariate analyses showed a significant statistical difference between the four patent lumbar arteries in the T2EL-related re-intervention group and three patent lumbar arteries in the non-T2EL group, indicating that if patients have a higher number of patent lumbar arteries, they would be more likely to suffer a re-intervention after EVAR.…”

Section: Discussionmentioning

confidence: 99%

A nomogram risk assessment model to predict the possibility of type II endoleak-related re-intervention after endovascular aneurysm repair (EVAR)

Liu

Chen

Qin

et al. 2023

Sci Rep

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This study aimed to develop and validate a novel nomogram risk assessment model to predict the possibility of type II endoleak (T2EL)-related re-intervention. The data of 455 patients with abdominal aortic aneurysms who underwent elective endovascular aneurysm repair (EVAR) procedures between January 2018 and December 2021 at our single center were retrospectively reviewed. Following the implementation of exclusion criteria, 283 patients were finally included and divided into T2EL-related re-intervention (n = 42) and non-T2EL (n = 241) groups. The overall T2EL-related re-intervention rate for 283 patients was 14.8% (42/283). Using multivariate analysis, significant risk factors for re-intervention included age (OR, 1.172; 95% CI, 1.051–1.307; P = 0.004), smoking (OR, 13.418; 95% CI, 2.362–76.215; P = 0.003), diameter of inferior mesenteric artery (IMA) (OR, 21.380; 95% CI, 3.060–149.390; P = 0.002), and number of patent lumbar arteries (OR, 9.736; 95% CI, 3.175–29.857; P < 0.001). The discrimination ability of this risk-predictive model was reasonable (concordance index [C-index] = 0.921; 95% CI, 0.878–0.964). The Hosmer–Lemeshow goodness of fit test was performed on the model, and the chi-square value was 3.210 (P = 0.920), presenting an excellent agreement between the model-predicted and observed values. The receiver operating characteristic (ROC) curve identified that the risk thresholds of re-intervention were a diameter of > 2.77 mm for the diameter of the inferior mesenteric artery and a proportion of < 45.5% for thrombus volume in the aneurysm sac. This novel nomogram risk assessment model for predicting the possibility of patients’ T2EL-related re-interventions after EVAR should be helpful in discriminating high-risk patients. Two novel risk thresholds may imply a higher possibility of T2EL-related re-intervention after EVAR.

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Risk Analysis of Aneurysm Sac Enlargement Caused by Type II Endoleak after Endovascular Aortic Repair

Cited by 14 publications

References 28 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

Impact of the Patency of Inferior Mesenteric Artery on 7-Year Outcomes After Endovascular Aneurysm Repair

A nomogram risk assessment model to predict the possibility of type II endoleak-related re-intervention after endovascular aneurysm repair (EVAR)

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