Long-term outcomes and interventions of postoperative type IA endoleaks after elective endovascular aneurysm repair.

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Journal of Vascular Surgery


Objective This study evaluated the incidence and long-term outcomes of postoperative type IA endoleak (PT1A) after endovascular aneurysm repair (EVAR). Methods Following Institutional Review Board approval, a retrospective review of consecutive aortoiliac EVARs performed at a single institution between June 2006 and June 2012 was conducted. Patients with an indication of nonruptured infrarenal abdominal aortic aneurysm were included, and those without follow-up were excluded from the study. Patients' demographics, comorbidities, preoperative evaluation, intraoperative details, and postoperative complications were collected. PT1A was identified by postoperative imaging follow-up. PT1A patients were compared with those who had persistent intraoperative type IA endoleak (IT1A) on completion angiography during initial EVAR that had resolved on initial follow-up imaging. Results There were 627 patients who underwent EVAR at our institution during the designated period, with a final cohort of 389 patients after inclusion and exclusion criteria were applied. Average length of follow-up was 68.8 months (0-194 months). The incidence of PT1A was 8.2 % (n = 32). Compared with the total cohort, those who developed PT1A were statistically more likely to be male (P = .03) and to have a higher all-cause mortality (P < .001) and aorta-related mortality (P = .03). Mean time to presentation was 52.3 months. Of the 32 PT1A patients, 5 (15.6%) presented with aortic rupture, of whom 3 underwent extension cuff placement, 1 had open graft explantation, and 1 declined intervention. Six patients in total (18.7%) declined intervention. Within the 26 PT1A patients who had intervention, 21 (80.7%) showed resolution of PT1A and 5 (19.2%) had recurrence. For patients with recurrent PT1A, three refused further intervention and two had extension cuff placement. Patients with PT1A who had intervention with resolution had significantly increased all-cause mortality compared with the total EVAR cohort (P = .02). Within the PT1A cohort, six (18.7%) had IT1A on completion angiography, with a mean time to presentation of 39 months. Four underwent intervention, all with resolution of the type IA endoleak. IT1A was associated with a significantly decreased median survival (P = .003), but there was no aorta-related mortality. Conclusions The development of PT1A after elective EVAR is associated with increased aorta-related mortality and presented an average of 52 months postoperatively within our cohort. This underscores the importance of long-term follow-up surveillance. Patients with PT1A who had a successful intervention still demonstrated an increase in all-cause mortality. The incidence of IT1A may decrease median survival but was not associated with aorta-related mortality.





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