Type 1b Endoleaks After Thoracic Endovascular Aortic Repair are Inadequately Reported: A Systematic Review

Abstract

Background: Complications after thoracic endovascular aortic repair (TEVAR) are common. Even after a successful TEVAR, a late endoleak (>30 days) can occur. The objective of this study is to summarize the current evidence and, if lacking, the need of evidence regarding the incidence and predictive factors for type 1b endoleak in patients with aortic aneurysm treated with TEVAR. Methods: A systematic review of the literature was performed on endoleak type 1b, in patients with aortic aneurysm, after TEVAR. The PubMed and Embase databases were systematically searched for articles regarding endoleak type 1b up to January 2019. The main subjects discussed are the incidence, risk factors, treatment, and prognosis. Results: About 722 articles were screened, and 16 articles were included in this review. The reported incidence of endoleak is between 1.0% and 15.0%, with a mean follow-up duration of at least 1 year. Type 1b endoleak is associated with an increased aortic tortuosity index (>0.15 cm À1). No significant difference is found in relation to age and gender. Treatment is required in most cases (22/27) and is usually performed with distal extension of the stent graft (21/27). There are no data regarding stent graft oversizing, length of distal landing zone, and differences between devices or the prognosis for patients with type 1b endoleak. Conclusions: Limited literature is available on the occurrence of type 1b endoleak after TEVAR. A tortuous aorta can be associated as a predictive factor for the occurrence of type 1b endoleak. Data clearly delineating the anatomic variables predicting type 1b endoleak should be examined and listed. Likewise, the impact of more recent conformable devices to prevent complications like type 1b endoleaks from occurring should be elucidated.

Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reintervention

“…It is difficult to compare our series to other endovascular procedures in the thoracic aorta, given that even in TEVAR procedures, the incidence of type 1b endoleak has not been quantified owing to a lack of published data. 13 We have clearly demonstrated that appropriate oversizing and sealing length of the distal stent results in decreased postoperative endoleak and need for reintervention. In some of these cases, preoperative selection of a larger distal stent may have prevented endoleak.…”

“…It is difficult to compare our series to other endovascular procedures in the thoracic aorta, given that even in TEVAR procedures, the incidence of type 1b endoleak has not been quantified owing to a lack of published data. 13 …”

Outcomes of thoracic endovascular aortic repair in thoracic aortic aneurysm and penetrating aortic ulcer using the Conformable Gore TAG within and outside the instructions for use

“…A recent meta-analysis reports the incidence of EL-Ib as up to 8%. 33 Interestingly, none of the evaluated articles reported on the influence of DLZ length. Furthermore, no study mentioned evaluated IFU adherence.…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…Complications after TEVAR are not rare. The reported incidence of type Ib endoleak 1 year after TEVAR is between 1.0% and 15.0%, with a tortuous aorta being a predictor of endoleak [327] and therefore require surveillance.…”