Type 2 Endoleak With or Without Intervention and Survival After Endovascular Aneurysm Repair

Abstract

WHAT THIS PAPER ADDSA type 2 endoleak (T2EL) following endovascular aneurysm repair (EVAR) is associated with an increased need for secondary intervention and presumed risk of rupture, thus analysing the impact of an isolated T2EL on mortality is necessary. After an 11 year follow up, survival in patients who underwent a secondary intervention for T2EL was not better than those who were treated conservatively. Most importantly, this study highlights the need for a conservative approach and for high quality prospective studies to better understand the natural course of T2EL, and to guide the direction of their management.Objective: The aims of the present study were to examine the impact of type 2 endoleaks (T2EL) on overall survival and to determine the need for secondary intervention after endovascular aneurysm repair (EVAR). Methods: A multicentre retrospective cohort study in the Netherlands was conducted among patients with an infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between 2007 and 2012. The primary endpoint was overall survival for patients with (T2ELþ) or without (T2EL-) a T2EL. Secondary endpoints were sac growth, AAA rupture, and secondary intervention. KaplaneMeier survival and multivariable Cox regression analysis were used. Results: A total of 2 018 patients were included. The median follow up was 62.1 (range 0.1 e 146.2) months. No difference in overall survival was found between T2ELþ (n ¼ 388) and T2EL-patients (n ¼ 1630) (p ¼ .54). The overall survival estimates at five and 10 years were 73.3%/69.4% and 45.9%/44.1% for T2ELþ/T2EL-patients, respectively. Eighty-five of 388 (21.9%) T2ELþ patients underwent a secondary intervention. There was no difference in overall survival between T2ELþ patients who underwent a secondary intervention and those who were treated conservatively (p ¼ .081). Sac growth was observed in 89 T2ELþ patients and 44/89 patients (49.4%) underwent a secondary intervention. In 41/44 cases (93.1%), sac growth was still observed after the intervention, but was left untreated. Aneurysm rupture occurred in 4/388 T2EL patients. In Cox regression analysis, higher age, ASA classification, and maximum iliac diameter were significantly associated with worse overall survival. Conclusion:No difference in overall survival was found between T2ELþ and T2EL-patients. Also, patients who underwent a secondary intervention did not have better survival compared with those who did not undergo a secondary intervention. This study reinforces the need for conservative treatment of an isolated T2EL and the importance of a prospective study to determine possible advantages of the intervention.

Comparative study between Endovascular versus Open surgical management of Infra-renal Aortic Aneurysm

“…Endoleak following EVAR was less common in the present research (6.7 percent) than it had been in previous studies (12 percent) [19]. The most common reason for subsequent intervention is an endoleak [20]. Endoleaks following open surgery are uncommon, although one has been documented [21].…”

Analysis of Outcomes After Endovascular Abdominal Aortic Aneurysm Repair in Patients With Abnormal Findings on the First Postoperative Computed Tomography Angiography

“…Recently published data from our research group compared patients with and without a type II endoleak, which showed that overall survival was unaffected by the presence of a type II endoleak (p=0.537). 16 However, this type II endoleak study included patients with and without abnormalities at their initial CTA, therefore, the results are not directly comparable. Baderkhan et al 11 also demonstrated no difference in overall survival in patients classified as high (sealing zone less than 10 mm and/or presence of an endoleak) and low risk on the first postoperative CTA of adverse events after EVAR (log rank; p=0.077).…”

Patient-Reported Outcomes of Yearly Imaging Surveillance in Patients Following Endovascular Aortic Aneurysm Repair

“…30 However, in the Netherlands the majority of the imaging follow-up is performed with ultrasound. 31 Health care providers must be aware of the difference in anxiety levels and the associated imaging modalities.…”