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Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion.

Publication ,  Journal Article
Gallagher, KA; Ravin, RA; Meltzer, AJ; Khan, MA; Coleman, DM; Graham, AR; Aiello, F; Shrikhande, G; Connolly, PH; Dayal, R; Karwowski, JK
Published in: J Endovasc Ther
April 2012

PURPOSE: To examine the outcomes following interventions for type II endoleaks in patients with aneurysm sac expansion after endovascular aneurysm repair (EVAR). METHODS: A retrospective review was conducted of all patients who underwent treatment for type II endoleak from July 2001 to September 2010 in a single center. In this time period, 29 (4.7%) patients (22 men; mean age 78.6 years, range 54-87) were identified as having a type II endoleak and enlargement of the aneurysm sac, meeting the criterion for treatment. All patients had at least one attempted percutaneous intervention. Patients were followed both clinically and radiographically, with computed tomographic angiography every 3 to 12 months, over a follow-up period that ranged from 1 to 10 years (mean 3.5). RESULTS: Forty-eight interventions were performed on the 29 patients. Of these, 15 (56%) patients underwent multiple (2-4) procedures. Of the 11 endoleaks with an isolated inferior mesenteric artery identified as the source, initial success for transarterial embolization at 2 years was 72%, with 2 of the failures having successful secondary interventions. For the 18 endoleaks with a lumbar source, the success of the initial intervention was 17% at 2 years; repeated embolization attempts produced a 40% secondary success rate. Seven (24%) patients had continued endoleak despite multiple treatment attempts; 3 ultimately required elective aortic graft explantation. There were no ruptures or deaths during the study period. In a comparison of type II endoleak patients who had stable aneurysm sacs and those who had persistent sac expansion, the only significant differences in preoperative anatomical characteristics were a lower prevalence of mural thrombus (p = 0.036) and longer right iliac arteries (p = 0.012) in the group with sac expansion. Independent predictors of type II endoleak were mural thrombus (p<0.001), patent lumbar arteries (p = 0.004), aneurysm length (p = 0.011), and iliac artery length (p = 0.004). CONCLUSION: This study demonstrates that most patients require multiple reinterventions to treat type II endoleaks; specifically, lumbar artery embolization carries a low midterm success rate.

Duke Scholars

Published In

J Endovasc Ther

DOI

EISSN

1545-1550

Publication Date

April 2012

Volume

19

Issue

2

Start / End Page

182 / 192

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Time Factors
  • Stents
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Reoperation
  • Prosthesis Design
  • Predictive Value of Tests
 

Citation

APA
Chicago
ICMJE
MLA
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Gallagher, K. A., Ravin, R. A., Meltzer, A. J., Khan, M. A., Coleman, D. M., Graham, A. R., … Karwowski, J. K. (2012). Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. J Endovasc Ther, 19(2), 182–192. https://doi.org/10.1583/11-3653.1
Gallagher, Katherine A., Reid A. Ravin, Andrew J. Meltzer, Muhammad A. Khan, Dawn M. Coleman, Ashley R. Graham, Francesco Aiello, et al. “Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion.J Endovasc Ther 19, no. 2 (April 2012): 182–92. https://doi.org/10.1583/11-3653.1.
Gallagher KA, Ravin RA, Meltzer AJ, Khan MA, Coleman DM, Graham AR, et al. Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. J Endovasc Ther. 2012 Apr;19(2):182–92.
Gallagher, Katherine A., et al. “Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion.J Endovasc Ther, vol. 19, no. 2, Apr. 2012, pp. 182–92. Pubmed, doi:10.1583/11-3653.1.
Gallagher KA, Ravin RA, Meltzer AJ, Khan MA, Coleman DM, Graham AR, Aiello F, Shrikhande G, Connolly PH, Dayal R, Karwowski JK. Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. J Endovasc Ther. 2012 Apr;19(2):182–192.
Journal cover image

Published In

J Endovasc Ther

DOI

EISSN

1545-1550

Publication Date

April 2012

Volume

19

Issue

2

Start / End Page

182 / 192

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Time Factors
  • Stents
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Reoperation
  • Prosthesis Design
  • Predictive Value of Tests