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Erschienen in: Wiener klinische Wochenschrift 21-22/2015

01.11.2015 | original article

Length of abdominal aortic aneurysm and incidence of endoleaks type II after endovascular repair

verfasst von: cand, med Dinh Dong Nghi Phan, Prof. Dr. med. habil. Frank Meyer, Prof. Dr. med. habil. Maciej Pech, Priv-Doz. Dr. med. habil. Zuhir Halloul

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 21-22/2015

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Summary

Objective

To evaluate the predicting factors for the development of endoleak type II, its frequency and influencing factors after elective endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA).

Methods

Data were prospectively collected in a unicenter observational study (tertiary center of [endo-] vascular surgery) and retrospectively evaluated in patients who had undergone elective EVAR of AAA. Vascular (lumbar arteries (LA) and inferior mesenteric artery, aneurysm) and general patient (habits, medication, basic diseases) as well as procedural characteristics, were analyzed for their association with the development of endoleak type II. Pre and postinterventional computed tomography (CT) scans were evaluated for aneurysm anatomy, in particular, postinterventional growth or shrinkage as well detection of an endoleak of each type.

Results

The study cohort included 82 patients (mean age, 72 (52–87) years; 77 men, 93.9 %) throughout 36 months. The median follow-up period was 29.5 months (range, 1–57). Overall, 51 endoleaks type II (62.2 %) were identified at any time during the postinterventional follow-up period. In the Cox regression, AAA length was the only significant predictor (P = 0.024; hazard ratio (HR), 1.07; 95 % confidence interval (CI), 1.01–1.14). Thirteen patients (15.8 %) underwent at least one secondary intervention. Aneurysm growth was observed in four patients because of an endoleak type II (4.9 %). No AAA rupture occurred in association with an isolated endoleak type II.

Conclusion

The preoperative AAA length (correlating with the number of LA) can be considered a risk factor for postinterventional occurrence of endoleak type II prompting to greater attention and possible preemptive therapy.
Literatur
1.
Zurück zum Zitat Ward TJ, Cohen S, Fischman AM, Kim E, Nowakowski FS, Ellozy SH, et al. Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol. 2013;24:49–55. CrossRefPubMed Ward TJ, Cohen S, Fischman AM, Kim E, Nowakowski FS, Ellozy SH, et al. Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol. 2013;24:49–55. CrossRefPubMed
2.
Zurück zum Zitat Zarins CK, Crabtree T, Bloch DA, Arko FR, Ouriel K, White RA. Endovascular aneurysm repair at 5 years: does aneurysm diameter predict outcome? J Vasc Surg. 2006;44:920–9. CrossRefPubMed Zarins CK, Crabtree T, Bloch DA, Arko FR, Ouriel K, White RA. Endovascular aneurysm repair at 5 years: does aneurysm diameter predict outcome? J Vasc Surg. 2006;44:920–9. CrossRefPubMed
3.
Zurück zum Zitat Golzarian J, Valenti D. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment. Eur Radiol. 2006;16:2849–57. CrossRefPubMed Golzarian J, Valenti D. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment. Eur Radiol. 2006;16:2849–57. CrossRefPubMed
4.
Zurück zum Zitat Jonker FH, Aruny J, Muhs BE. Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg. 2009;22:165–71. CrossRefPubMed Jonker FH, Aruny J, Muhs BE. Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg. 2009;22:165–71. CrossRefPubMed
5.
Zurück zum Zitat Sarac TP, Gibbons C, Vargas L, Liu J, Srivastava S, Bena J, et al. Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg. 2012;55:33–40. CrossRefPubMed Sarac TP, Gibbons C, Vargas L, Liu J, Srivastava S, Bena J, et al. Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg. 2012;55:33–40. CrossRefPubMed
6.
Zurück zum Zitat Sampaio SM, Shin SH, Panneton JM, Andrews JC, Bower TC, Cherry KJ, et al. Intraoperative endoleak during EVAR: frequency, nature, and significance. Vasc Endovascular Surg. 2009;43:352–9. CrossRefPubMed Sampaio SM, Shin SH, Panneton JM, Andrews JC, Bower TC, Cherry KJ, et al. Intraoperative endoleak during EVAR: frequency, nature, and significance. Vasc Endovascular Surg. 2009;43:352–9. CrossRefPubMed
7.
Zurück zum Zitat El Batti S, Cochennec F, Roudot-Thoraval F, Becquemin J. Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg. 2013;57:1291–7. CrossRef El Batti S, Cochennec F, Roudot-Thoraval F, Becquemin J. Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg. 2013;57:1291–7. CrossRef
8.
Zurück zum Zitat Maldonado TS, Gagne PJ. Controversies in the management of type II “branch” endoleaks following endovascular abdominal aortic aneurysm repair. Vasc Endovascular Surg. 2003;37:1–12. CrossRefPubMed Maldonado TS, Gagne PJ. Controversies in the management of type II “branch” endoleaks following endovascular abdominal aortic aneurysm repair. Vasc Endovascular Surg. 2003;37:1–12. CrossRefPubMed
9.
Zurück zum Zitat Matsumura JS, Pearce WH, McCarthy WJ, Yao JS. Reduction in aortic aneurysm size: early results after endovascular graft placement. EVT Investigators. J Vasc Surg. 1997;25:113–23. CrossRefPubMed Matsumura JS, Pearce WH, McCarthy WJ, Yao JS. Reduction in aortic aneurysm size: early results after endovascular graft placement. EVT Investigators. J Vasc Surg. 1997;25:113–23. CrossRefPubMed
10.
Zurück zum Zitat Fairman RM, Nolte L, Snyder SA, Chuter TA, Greenberg RK; Zenith Investigators. Factors predictive of early or late aneurysm sac size change following endovascular repair. J Vasc Surg. 2006;43:649–56. CrossRefPubMed Fairman RM, Nolte L, Snyder SA, Chuter TA, Greenberg RK; Zenith Investigators. Factors predictive of early or late aneurysm sac size change following endovascular repair. J Vasc Surg. 2006;43:649–56. CrossRefPubMed
11.
Zurück zum Zitat Oberhuber A, Buecken M, Hoffmann M, Orend K, Muehling BM. Comparison of aortic neck dilatation after open and endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2012;55:929–34. CrossRefPubMed Oberhuber A, Buecken M, Hoffmann M, Orend K, Muehling BM. Comparison of aortic neck dilatation after open and endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2012;55:929–34. CrossRefPubMed
12.
Zurück zum Zitat Hinchliffe RJ, Singh-Ranger R, Davidson IR, Hopkinson BR. Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg. 2001;22:563–5. CrossRefPubMed Hinchliffe RJ, Singh-Ranger R, Davidson IR, Hopkinson BR. Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg. 2001;22:563–5. CrossRefPubMed
13.
Zurück zum Zitat Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases. J Vasc Surg. 2000;31:599–606. CrossRefPubMed Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases. J Vasc Surg. 2000;31:599–606. CrossRefPubMed
14.
Zurück zum Zitat Dudeck O, Schnapauff D, Herzog L, Löwenthal D, Bulla K, Bulla B. Can early computed tomography angiography after endovascular aortic aneurysm repair predict the need for reintervention in patients with type II endoleak? Cardiovasc Intervent Radiol. 2015; 38:45–52. CrossRefPubMed Dudeck O, Schnapauff D, Herzog L, Löwenthal D, Bulla K, Bulla B. Can early computed tomography angiography after endovascular aortic aneurysm repair predict the need for reintervention in patients with type II endoleak? Cardiovasc Intervent Radiol. 2015; 38:45–52. CrossRefPubMed
15.
Zurück zum Zitat Jones JE, Atkins MD, Brewster DC, Chung TK, Kwolek CJ, LaMuraglia GM, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007;46:1–8. CrossRefPubMed Jones JE, Atkins MD, Brewster DC, Chung TK, Kwolek CJ, LaMuraglia GM, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007;46:1–8. CrossRefPubMed
16.
Zurück zum Zitat Marchiori A, von Ristow A, Guimaraes M, Schönholz C, Uflacker R. Predictive factors for the development of type II endoleaks. J Endovasc Ther. 2011;18:299–305. CrossRefPubMed Marchiori A, von Ristow A, Guimaraes M, Schönholz C, Uflacker R. Predictive factors for the development of type II endoleaks. J Endovasc Ther. 2011;18:299–305. CrossRefPubMed
17.
Zurück zum Zitat Walker SR, Macierewicz J, Hopkinson BR. Endovascular AAA repair: prevention of side branch endoleaks with thrombogenic sponge. J Endovasc Surg. 1999;6:350–3. CrossRefPubMed Walker SR, Macierewicz J, Hopkinson BR. Endovascular AAA repair: prevention of side branch endoleaks with thrombogenic sponge. J Endovasc Surg. 1999;6:350–3. CrossRefPubMed
18.
Zurück zum Zitat Krievins DK, Holden A, Savlovskis J, Calderas C, Donayre CE, Moll FL, et al. EVAR using the Nellix Sac-anchoring endoprosthesis: treatment of favourable and adverse anatomy. Eur J Vasc Endovasc Surg. 2011;42:38–46. CrossRefPubMed Krievins DK, Holden A, Savlovskis J, Calderas C, Donayre CE, Moll FL, et al. EVAR using the Nellix Sac-anchoring endoprosthesis: treatment of favourable and adverse anatomy. Eur J Vasc Endovasc Surg. 2011;42:38–46. CrossRefPubMed
19.
Zurück zum Zitat Steinmetz E, Rubin BG, Sanchez LA, Choi ET, Geraghty PJ, Baty J, et al. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J Vasc Surg. 2004;39:306–13. CrossRefPubMed Steinmetz E, Rubin BG, Sanchez LA, Choi ET, Geraghty PJ, Baty J, et al. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J Vasc Surg. 2004;39:306–13. CrossRefPubMed
Metadaten
Titel
Length of abdominal aortic aneurysm and incidence of endoleaks type II after endovascular repair
verfasst von
cand, med Dinh Dong Nghi Phan
Prof. Dr. med. habil. Frank Meyer
Prof. Dr. med. habil. Maciej Pech
Priv-Doz. Dr. med. habil. Zuhir Halloul
Publikationsdatum
01.11.2015
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 21-22/2015
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0871-y