Purpose: To determine, based on preoperative imaging findings, which patients treated with endovascular abdominal aneurysm repair are at high risk for the development of persistent type II endoleaks.
Materials and methods: Preoperative computed tomography (CT) angiographies of 136 patients, treated endovascularly, were retrospectively examined for possible anatomic predictors of type II endoleak development. Specifically, the number of patent aortic branches and thrombus load parameters (i.e., thickness, perimeter, area, and localization) were recorded. Thrombus load parameters were evaluated at the level of maximum aneurysm diameter, at the level of sac lumbar arteries' ostia, and at the level of inferior mesenteric artery ostium. Follow-up CT angiographies were also studied for the presence of persistent type II endoleaks (present at six-month follow-up examination). The association of these anatomic features with the development of persistent type II endoleaks was assessed using logistic regression analysis.
Results: Aortic branch patency increased the risk for persistent type II endoleak development, while thrombus load parameters decreased this risk. In multiple logistic regression analysis, the total number of patent aortic branches (odds ratio = 4.23, 95% confidence interval = 1.72-10.42, P = 0.002 for each additional branch), and the percentage of aortic perimeter covered by a thrombus at the level of the sac lumbar arteries' ostia (odds ratio = 0.16, 95% confidence interval = 0.06-0.44, P < 0.001 for a 15% increase) were independent predictors.
Conclusion: Anatomic characteristics of a preoperative aorta can be used to predict patients with higher risk for persistent type II endoleak development.