Enrico Cieri1, Paola De Rango1, Giacomo Isernia1, Gioele Simonte1, Andrea Ciucci1, Gianbattista Parlani1, Fabio Verzini1, Piergiorgio Cao2
1Vascular and Endovascular Surgery; University of Perugia, Perugia, Italy; 2Unit of Vascular Surgery, Hospital S. Camillo Forlanini, Rome, Italy.
OBJECTIVES: To analyze predictors and long-term consequence of Type II endoleak in a large series of elective EVAR.
METHODS: Baseline characteristics, operative and follow-up data of consecutive patients undergoing EVAR were prospectively collected. Patients who developed Type II endoleak according to CT scan and those without were compared for baseline characteristic, mortality, re-intervention, conversion and aneurysm growth after repair.
RESULTS: 1,412 consecutive patients (91.4% males; mean age 72.9) underwent elective EVAR in 1997-2012 and were subsequently followed for a mean of 54±42 months. Two hundred eighteen developed Type II endoleak. Multivariate analysis failed to identify Type II endoleak significant independent predictors with the exception of age (p=0.026; OR1.023) and neck thrombus (p=0.011; OR.303). Rates of Type II endoleak were comparable regardless the type of device, but there was a tendency for lower rate with most recent generation devices. Freedom from aneurysm sac growth >5mm (95.2% vs. 42.4%; p<0.001) re-intervention (92.3% vs. 49.6%; p<0.001) or conversion (98.5% vs. 80%; p<0.001) at 120 months was higher in patients without Type II endoleak.
Fifty-two patients with Type II endoleak underwent re-intervention. At 60 months, rates of persisting Type II endoleak were similar among patients with and without re-interventions (49.8% vs. 45.6%).There were no significant difference in persisting aneurysm growth >5mm in Type II endoleak patients after re-intervention and those who remained untreated (57.1% vs. 42.6%). Cox regression identified Type II endoleak as independent predictor of aneurysm growth along with age and cardiac disease. There were 4 aneurysm ruptures during follow-up in patients with Type II endoleak. Late aneurysm related mortality at 120 months was 3.8% vs. 2.1% for patients with and without Type II endoleak
CONCLUSIONS: Type II endoleak is a common marker of EVAR failure reflecting multiple meanings. Occurrence and consequences are challenging to be predicted and treatment with re-interventions often results in failure
AUTHOR DISCLOSURES: P. Cao: Nothing to disclose; E. Cieri: Nothing to disclose; A. Ciucci: Nothing to disclose; P. De Rango: Nothing to disclose; G. Isernia: Nothing to disclose; G. Parlani: Nothing to disclose; G. Simonte: Nothing to disclose; F. Verzini: Nothing to disclose.
Posted April 2013