Does type II endoleak with an enlarging aortic sac predispose to development of a type IA endoleak?
Journal of Vascular Surgery
Objective The most common endoleak after endovascular aneurysm repair is type II endoleak (T2EL). Whereas T2ELs are generally considered benign, there have been reports that they can lead to aortic rupture. In this report, we reviewed the effect of T2EL on sac size changes to determine whether sac expansion due to a T2EL could result in the development of a type IA endoleak. Methods After Institutional Review Board approval, all aortoiliac endovascular aneurysm repairs performed at a single institution between June 2006 and June 2012 were retrospectively reviewed. Patients' demographics, comorbidities, aneurysm diameter, graft type, need for reintervention, and complications were collected. Patients with T2EL diagnosed on follow-up imaging were categorized as those who underwent intervention for the T2EL and those who did not. Outcomes were tabulated with attention to sac size change, development of type IA endoleak, rupture, and survival. Results At our institution during this time, 627 patients underwent aortoiliac stent graft placement. Patients with an operative indication other than nonruptured infrarenal abdominal aortic aneurysm and those who did not have a preoperative computed tomography angiography image available or follow-up data were excluded. The total number of patients included was 389, with an average follow-up of 68.8 months (range, 0-194 months). Follow-up imaging diagnosed 125 patients with T2EL (32%). Patients with T2EL were significantly more likely to have a smoking history (P = .01), hypertension (P < .05), and older age (P < .0001). Patients with T2EL had a significantly larger sac size increase than patients without T2EL (9.50 vs –0.78 mm; P < .0001). Patients with T2EL were significantly more likely to develop a type IA endoleak than patients who did not have T2EL (14% vs 6%; P = .02), but the rate of rupture was not significantly different (4% vs 2%; P = .33). Those patients in the T2EL group who underwent intervention for T2EL survived significantly longer than patients who did not undergo intervention (100.5 vs 75 months; P = .0040). Conclusions Our data suggest that there is an increased incidence of late type IA endoleak in patients with T2EL and an enlarging aortic sac. Our study also demonstrates an increased overall survival in T2EL patients who underwent intervention. Future studies are necessary to better define the association between T2EL with enlarging abdominal aortic aneurysm sac and the development of type IA endoleaks.
Eden CL, Long G, Major M, Studzinski D, Brown OW. PC010. Does type II endoleak with an enlarging aortic sac predispose to development of a type IA endoleak?. J Vascular Surg 2019 Jun 1;69(6):e206.