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J Vasc Surg. 2015 Sep;62(3):551-61. doi: 10.1016/j.jvs.2015.04.389. Epub 2015 Jun 6.

Type II endoleak with or without intervention after endovascular aortic aneurysm repair does not change aneurysm-related outcomes despite sac growth.

Author information

1
Department of Surgery, University of California, San Francisco, San Francisco, Calif.
2
Division of Research, Kaiser Permanente, Oakland, Calif.
3
Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
4
Department of Surgery, University of California, San Francisco-East Bay Medical Center, Oakland, Calif.
5
Division of Vascular Surgery, The Permanente Medical Group, San Francisco, Calif.
6
Division of Vascular Surgery, The Permanente Medical Group, Santa Clara, Calif.
7
Division of Vascular Surgery, The Permanente Medical Group, South San Francisco, Calif. Electronic address: robert.w.chang@kp.org.

Abstract

OBJECTIVE:

There is considerable controversy about the significance and appropriate treatment of type II endoleaks (T2Ls) after endovascular aneurysm repair (EVAR). We report our long-term experience with T2L management in a large multicenter registry.

METHODS:

Between 2000 and 2010, 1736 patients underwent EVAR, and we recorded the incidence of T2L. Primary outcomes were mortality and aneurysm-related mortality (ARM). Secondary outcomes were change in aneurysm sac size, major adverse events, and reintervention.

RESULTS:

During the follow-up (median of 32.2 months; interquartile range, 14.2-52.8 months), T2L was identified in 474 patients (27.3%). There were no late abdominal aortic aneurysm ruptures attributable to a T2L. Overall mortality (P = .47) and ARM (P = .26) did not differ between patients with and without T2L. Sac growth (median, 5 mm; interquartile range, 2-10 mm) was seen in 213 (44.9%) of the patients with T2L. Of these patients with a T2L and sac growth, 36 (16.9%) had an additional type of endoleak. Of all patients with T2L, 111 (23.4%) received reinterventions, including 39 patients who underwent multiple procedures; 74% of the reinterventions were performed in patients with sac growth. Reinterventions included lumbar embolization in 66 patients (59.5%), placement of additional stents in 48 (43.2%), open surgical revision in 14 (12.6%), and direct sac injection in 22 (19.8%). The reintervention was successful in 35 patients (31.5%). After patients with other types of endoleak were excluded, no difference in overall all-cause mortality (P = .57) or ARM (P = .09) was observed between patients with T2L-associated sac growth who underwent reintervention and those in whom T2L was left untreated.

CONCLUSIONS:

In our multicenter EVAR registry, overall all-cause mortality and ARM were unaffected by the presence of a T2L. Moreover, patients who were simply observed for T2L-associated sac growth had aneurysm-related outcomes similar to those in patients who underwent reintervention. Our future work will investigate the most cost-effective ways to select patients for intervention besides sac growth alone.

PMID:
26059094
PMCID:
PMC5292251
DOI:
10.1016/j.jvs.2015.04.389
[Indexed for MEDLINE]
Free PMC Article

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