Preoperative risk factors for aneurysm sac expansion caused by type 2 endoleak after endovascular aneurysm repair

Abstract

Purpose

The objective of this study was to investigate the preoperatively definable risk factors which predict the aneurysm sac expansion caused by persistent type 2 endoleak after endovascular aneurysm repair.

Methods

Between 2008 and 2014, retrospective analysis was performed to examine the predictive risk factors for aneurysm sac enlargement caused by persistent type 2 endoleak, which was defined as a continuous endoleak present for more than six months. Aneurysm sac expansion was diagnosed if the maximum transverse diameter increased by 5 mm or more compared with the preoperative measurement.

Results

During the study period, endovascular aneurysm repair was performed in 211 patients with abdominal aortic aneurysm and common iliac artery aneurysm. Sac enlargement for type 2 endoleaks was observed in 20 patients (9.5%). The presence of more than five patent lumbar arteries flowing into aneurysm sac in the preoperative computed tomography (hazard ratio, 3.37; 95% confidence interval, 1.24–10.8; p = 0.017) was a predictive factor for sac expansion caused by persistent type 2 endoleak on Cox regression analysis. The presence of a patent inferior mesenteric artery was not associated with the sac expansion caused by persistent type 2 endoleak.

Conclusions

The presence of more than five lumbar arteries flowing into the aneurysm sac was a preoperative risk factor for sac expansion caused by persistent type 2 endoleak.

Keywords

Abdominal aortic aneurysm endovascular aneurysm repair type 2 endoleak

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References

Schermerhorn

Buck

O'Malley

et al.

Long-term outcomes of abdominal aortic aneurysm in the medicare population. N Engl J Med 2015; 373: 328–338.

Conrad

Adams

Guest

et al.

Secondary intervention after endovascular abdominal aortic aneurysm repair. Ann Surg 2009; 250: 383–389.

Chung

Morgan

. Type 2 Endoleaks post-EVAR: current evidence for rupture risk, intervention and outcomes of treatment. Cardiovasc Intervent Radiol 2015; 38: 507–522.

Silverberg

Baril

Ellozy

et al.

An 8-year experience with type II endoleaks: natural history suggests selective intervention is a safe approach. J Vasc Surg 2006; 44: 453–459.

van Marrewijk

Fransen

Laheij

et al.

Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg 2004; 27: 128–137.

Abularrage

Crawford

Conrad

et al.

Preoperative variables predict persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg 2010; 52: 19–24.

Fukuda

Matsuda

Sanda

et al.

CT Findings of risk factors for persistent type II endoleak from inferior mesenteric artery to determine indicators of preoperative IMA embolization. Ann Vasc Dis 2014; 7: 274–279.

Otsu

Ishizaka

Watanabe

et al.

Analysis of anatomical risk factors for persistent type II endoleaks following endovascular abdominal aortic aneurysm repair using CT angiography. Surg Today 2016; 46: 48–55.

Müller-Wille

Schötz

Zeman

et al.

CT features of early type II endoleaks after endovascular repair of abdominal aortic aneurysms help predict aneurysm sac enlargement. Radiology 2015; 274: 906–916.

10.

Fujimura

Obara

Matsubara

et al.

Characteristics and risk factors for type 2 endoleak in an East Asian population from a Japanese multicenter database. Circ J 2016; 80: 118–123.

11.

Armon

Yusuf

Whitaker

et al.

Thrombus distribution and changes in aneurysm size following endovascular aortic aneurysm repair. Eur J Vasc Endovasc Surg 1998; 16: 472–476.

12.

Mousa

Dayal

Bernheim

et al.

A canine model to study the significance and hemodynamics of type II endoleaks. J Surg Res 2005; 123: 275–283.

13.

Dayal

Mousa

Bernheim

et al.

Characterization of retrograde collateral (type II) endoleak using a new canine model. J Vasc Surg 2004; 40: 985–994.

14.

Marchiori

von Ristow

Guimaraes

et al.

Predictive factors for the development of type II endoleaks. J Endovasc Ther 2011; 18: 299–305.

15.

Görich

Rilinger

Sokiranski

et al.

Endoleaks after endovascular repair of aortic aneurysm: are they predictable? Initial results. Radiology 2001; 218: 477–480.

16.

Löwenthal

Herzog

Rogits

et al.

Identification of predictive CT angiographic factors in the development of high-risk type 2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms. Rofo 2015; 187: 49–55.

17.

AbuRahma

Mousa

Campbell

et al.

The relationship of preoperative thrombus load and location to the development of type II endoleak and sac regression. J Vasc Surg 2011; 53: 1534–1541.

18.

Sheehan

Ouriel

Greenberg

et al.

Are type II endoleaks after endovascular aneurysm repair endograft dependent?

J Vasc Surg 2006; 43: 657–661.

19.

Pini

Faggioli

Mascoli

et al.

Influence of statin therapy on type 2 endoleak evolution. Ann Vasc Surg 2015; 29: 1167–1173.

20.

Puri

Nicholls

Shao

et al.

Impact of statins on serial coronary calcification during atheroma progression and regression. J Am Coll Cardiol 2015; 65: 1273–1282.

21.

Johnson

Chiang

Eldrup-Jorgensen

et al.

Effect of chronic oral anticoagulation with warfarin on the durability and outcomes of endovascular aortic aneurysm repair. J Vasc Surg 2013; 58: 319–323.

22.

Wild

Dattani

Stather

et al.

Effect of anticoagulation and antiplatelet therapy on incidence of endoleaks and sac size expansions after endovascular aneurysm repair. Ann Vasc Surg 2014; 28: 554–559.

23.

Aoki

Suezawa

Sangawa

et al.

Effect of type II endoleaks and antiplatelet therapy on abdominal aortic aneurysm shrinkage after endovascular repair. J Vasc Surg 2011; 54: 947–951.

24.

Maeda

Ito

Kurimoto

et al.

Risk factors for a persistent type 2 endoleak after endovascular aneurysm repair. Surg Today 2015; 45: 1373–1377.

25.

Gallitto

Gargiulo

Mascoli

et al.

Persistent type II endoleak after EVAR: the predictive value of the AAA thrombus volume. J Cardiovasc Surg (Torino). Epub ahead of print 29 July 2015.

26.

Ikoma

Nakai

Sato

et al.

Systolic sac pressure index for the prediction of persistent type II endoleak for 12 months after endovascular abdominal aortic aneurysm repair. Cardiovasc Intervent Radiol 2016; 39: 522–529.