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The natural history of type II endoleaks after endovascular aneurysm repair for ruptured abdominal aortic aneurysm.
J Vasc Surg. 2016 Dec; 64(6):1645-1651.JV

Abstract

OBJECTIVE

The natural history of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) remains elusive; as such, treatment guidelines are ill defined. The purpose of this study was to better delineate the natural history of T2EL after EVAR for rAAA in an effort to determine the need for reintervention and optimal surveillance.

METHODS

A retrospective record review was conducted of all patients undergoing EVAR for rAAA in two large tertiary care academic vascular centers. Patient demographics, comorbidities, anatomic variables, and operative details were analyzed. Primary outcomes included the presence of T2EL, reintervention, delayed rupture, and aneurysm-related death.

RESULTS

EVAR was used to treat rAAA in 56 patients between 2000 and 2013. Mean follow-up of this cohort was 634 days. Completion arteriogram demonstrated T2ELs in 12 patients (21%), and an additional four T2ELs (7%) were found by postoperative computed tomography angiogram that were not identified on the completion angiogram. Body mass index was the only statistically significant variable associated with the development of T2EL (P = .03). Preoperative warfarin use, aortic thrombus burden, and device type did not correlate with T2EL development. Iliolumbar vessels supplied 75% (n = 12) of T2ELs. Of the 14 patients with T2ELs who underwent serial imaging postoperatively, six (43%) sealed spontaneously. Five patients (36%) underwent reintervention for T2EL by way of coil embolization-four in which treatment was initiated by attending preference. One patient was treated for ongoing anemia in the immediate postoperative period. There was no sac expansion, delayed rupture, or graft explantation.

CONCLUSIONS

T2ELs after EVAR for rAAA are common and appear to be associated with a benign natural history if left untreated. Although many will spontaneously seal early in the postoperative period, those that remain patent do not appear to increase the risk for sac expansion or delayed rupture or affect patient survival. As such, a conservative approach to treatment of T2ELs in rAAA may be warranted.

Authors+Show Affiliations

Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: john.rectenwald@utsouthwestern.edu.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27871492

Citation

Boniakowski, Anna E., et al. "The Natural History of Type II Endoleaks After Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm." Journal of Vascular Surgery, vol. 64, no. 6, 2016, pp. 1645-1651.
Boniakowski AE, De Martino RR, Coleman DM, et al. The natural history of type II endoleaks after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. J Vasc Surg. 2016;64(6):1645-1651.
Boniakowski, A. E., De Martino, R. R., Coleman, D. M., Eliason, J. L., Goodney, P. P., & Rectenwald, J. E. (2016). The natural history of type II endoleaks after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. Journal of Vascular Surgery, 64(6), 1645-1651. https://doi.org/10.1016/j.jvs.2016.04.063
Boniakowski AE, et al. The Natural History of Type II Endoleaks After Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm. J Vasc Surg. 2016;64(6):1645-1651. PubMed PMID: 27871492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The natural history of type II endoleaks after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. AU - Boniakowski,Anna E, AU - De Martino,Randall R, AU - Coleman,Dawn M, AU - Eliason,Jonathan L, AU - Goodney,Phillip P, AU - Rectenwald,John E, PY - 2016/02/08/received PY - 2016/04/28/accepted PY - 2016/11/23/entrez PY - 2016/11/23/pubmed PY - 2017/5/16/medline SP - 1645 EP - 1651 JF - Journal of vascular surgery JO - J Vasc Surg VL - 64 IS - 6 N2 - OBJECTIVE: The natural history of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) remains elusive; as such, treatment guidelines are ill defined. The purpose of this study was to better delineate the natural history of T2EL after EVAR for rAAA in an effort to determine the need for reintervention and optimal surveillance. METHODS: A retrospective record review was conducted of all patients undergoing EVAR for rAAA in two large tertiary care academic vascular centers. Patient demographics, comorbidities, anatomic variables, and operative details were analyzed. Primary outcomes included the presence of T2EL, reintervention, delayed rupture, and aneurysm-related death. RESULTS: EVAR was used to treat rAAA in 56 patients between 2000 and 2013. Mean follow-up of this cohort was 634 days. Completion arteriogram demonstrated T2ELs in 12 patients (21%), and an additional four T2ELs (7%) were found by postoperative computed tomography angiogram that were not identified on the completion angiogram. Body mass index was the only statistically significant variable associated with the development of T2EL (P = .03). Preoperative warfarin use, aortic thrombus burden, and device type did not correlate with T2EL development. Iliolumbar vessels supplied 75% (n = 12) of T2ELs. Of the 14 patients with T2ELs who underwent serial imaging postoperatively, six (43%) sealed spontaneously. Five patients (36%) underwent reintervention for T2EL by way of coil embolization-four in which treatment was initiated by attending preference. One patient was treated for ongoing anemia in the immediate postoperative period. There was no sac expansion, delayed rupture, or graft explantation. CONCLUSIONS: T2ELs after EVAR for rAAA are common and appear to be associated with a benign natural history if left untreated. Although many will spontaneously seal early in the postoperative period, those that remain patent do not appear to increase the risk for sac expansion or delayed rupture or affect patient survival. As such, a conservative approach to treatment of T2ELs in rAAA may be warranted. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/27871492/The_natural_history_of_type_II_endoleaks_after_endovascular_aneurysm_repair_for_ruptured_abdominal_aortic_aneurysm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(16)30372-X DB - PRIME DP - Unbound Medicine ER -