Reinterventions for type 2 endoleaks with enlargement of the aneurismal sac after endovascular treatment of abdominal aortic aneurysms

Abstract

Background: Type 2 endoleaks after the endovascular treatment (EVAR) of abdominal aorta aneurysms (AAAs) remain a concern for vascular surgeons, especially when they are associated with an enlargement of the persistent aneurysmal sac. The purpose of this study is to evaluate the effectiveness of secondary reinterventions for type 2 endoleaks associated with enlargement of the aneurysmal sac after EVAR.

Methods: The incidence of endoleaks, aneurysmal sac diameters, and reinterventions were collected from the clinical and radiologic data of the patients treated by EVAR for AAA with >1 year of follow-up. Patients with a type II endoleak associated with an enlargement of the aneurysmal sac were identified; their operative data and the results of the secondary procedures were recorded. The principal criterion of evaluation was the effectiveness of these reinterventions on the evolution of the diameter of the AAA. The secondary criteria were death rate related to aneurysm and the average costs of these additional procedures.

Results: In 232 patients treated by EVAR with an average of 2 years of follow-up (23 ± 30 months), 15 type I (6.5%), 94 type II (40.5%), and 8 type III (3.5%) endoleaks were identified. Among the 94 AAAs with a type II endoleak, 21 had a regression of the aneurysmal sac (22.5%), 46 were stable (49.5%), and 27 continued to grow (28%), including 9 because of another type of endoleak. Among the 18 patients presenting with a type II endoleak linked with an enlargement of the aneurysmal sac, 14 were treated with endovascular embolization, 1 was treated by conventional aneurysmectomy, and 3 patients were followed-up only. Among 14 patients treated by embolization, 9 (60%) presented with persistent enlargement of the aneurysmal sac after embolization, of which 5 were finally treated by conventional treatment with 1 postoperative death. The average cost per patient that required a reintervention for a type II endoleaks was €28,096 ± €30,490 ($37,530 ± $40,728).

Conclusion: Endovascular reinterventions for type II endoleaks associated with an enlargement of the aneurysmal sac after EVAR have a poor effectiveness on the stabilization of the diameter of the AAA. These procedures involve an high cost and high rates of morbidity, which should be taken into account in their use.