Treatment of the Progressive Endoleak Type 2 After EVAR

Abstract

An endoleak type 2 (EL2) is a relatively frequent event after an EVAR but 30-35% of EL2 can become progressive, which can cause a loss in the important sealing zone of the stent graft. Diagnosis is made by three-phase CT angiogram or by contrast-enhanced duplex scan. EL2 should be treated if the aortic sac grows more than 5 mm in 6 months time. The first suitable treatment is the endovascular approach with embolization of the inferior mesenteric artery (IMA) or lumbar arteries. Paravertebral puncture, under CT navigation to embolize the lumbar artery or a part of the aortic sac with the EL2, is another alternative. If the endovascular treatment is not successful in 2-3 times, we should consider a surgical approach. The operative approach can be a laparoscopic or an open operation: the laparoscopic approach allows us to clip the IMA and lumbar arteries. The open surgery involves laparotomy, ligation of the IMA, and endoaneurysmorrhaphy (suture of lumbar artery origins from inside) and then the suture of the aortic sac tightly around the stent graft in situ. The aortic occlusion balloon should be inserted below the renal arteries prior to open surgery. The surgical procedures have good outcomes and should be considered when the endovascular treatment is unsuccessful.

Early- and Mid-Term Results of Abdominal Endovascular Aneurysm Repair Using an Aortic Cuff Prior to the Main Body to Prevent Type II Endoleaks

“…11 We found that T2ELs occurred in 3 (33%) of 9 patients, equivalent to the incidence of T2ELs previously reported. 9 However, we did not perform contrast-enhanced CT for cases with no enlargement of the aneurysm sac in the last half year after surgery. Therefore, it was difficult to judge whether T2ELs were still persistent.…”

“…1 –4 Notably, endoleaks are considered a poor prognostic factor, among which T2ELs after EVAR are considered frequent, affecting approximately 25%–30% of patients. 9 Although approximately 80% of patients with T2ELs do not require reintervention, 9 persistent T2ELs have been reported as risk factors for aneurysm sac enlargement and reintervention. 5 Importantly, a previous study found that the risk factors for T2ELs are (1) IMA ≥3.0 mm, (2) LA ≥2.0 mm, and (3) presence of aortoiliac-type aneurysms.…”

Effectiveness Evaluation of Preventive Embolization of the Internal Iliac Artery in Preventing Type II Endoleaks

“…In 50% of cases, type II endoleaks are closed independently within a few months; in 10 to 15% of cases they can cause an increase in the diameter of the aneurysmal sac, and in 5 to 10% they can appear in the long-term after surgery. [5][6][7] Modern research data show that 54.2% of type II endoleaks are detected within up to 30 days of observation from the moment of surgery and 39.1% over 30 days, and of these only 8.4% are detected after a year from surgery. 8…”