Patients with interventions for
endoleak after
endovascular aortic repair from 2000 to 2016 were reviewed retrospectively. Patient demographics, comorbidities,
endoleak type, secondary procedures, aortic sac growth (≥5 mm), and mortality were collected. Successful treatment was defined as
endoleak resolution with no further aortic sac growth. Secondary procedures,
ruptures, endograft explant, and death were captured.
RESULTS: There were 130 patients diagnosed with a primary type II
endoleak after
endovascular aortic repair at a median of 1.3 months (interquartile range, 1.0-13.3 months). One hundred eighteen had their initial treatment for a primary type II. Twelve of the 130 were initially stable and observed, but were treated for a delayed type I or III
endoleak. The 130 patients underwent 279 procedures for
endoleaks (mean of 2.2 ± 1.3) over 6.9 ± 3.8 years of follow-up. Of the 118 patients treated for primary type II
endoleaks, 26 (22.0%) later required interventions for delayed type I and III
endoleaks. The mean time to intervention for a delayed type I or III
endoleak was 5.4 ± 2.8 years. Overall, there were 16 type IA, 11 type IB, 2 type III, 7 combined type IA/IB, and 2 type IA/III delayed
endoleaks. The odds of harboring a delayed type I or III
endoleak was 22.0% before the first attempt at type II
endoleak treatment, 35.1% before the second, 44.8% before the third, and 66.6% before the fourth attempts. Rapid aortic sac growth of ≥5 mm/y before initial
endoleak treatment was associated with increased risk for delayed type I or III
endoleak (47.8 vs 14.1%; P = .003). Patients with delayed type I or III
endoleaks had a lower successful treatment rate (8.3% vs 52.3%; P = .001) than those with only type II
endoleaks. Late
rupture was increased with delayed type I or III
endoleak (P = .002), whereas mortality (P = .96) and aortic-related mortality (P = .46) were similar. Graft explant (P = .06) trended toward an increase with a delayed type I or III
endoleak, but was not statistically significant.
CONCLUSIONS: