Type II endoleaks after fenestrated/branched endografting for juxtarenal and pararenal aortic aneurysms

Enrico Gallitto; Gian Luca Faggioli; Federica Campana; Francesca Maria Feroldi; Antonio Cappiello; Stefania Caputo; Rodolfo Pini; Mauro Gargiulo

doi:10.1016/j.jvs.2024.01.197

Type II endoleaks after fenestrated/branched endografting for juxtarenal and pararenal aortic aneurysms

J Vasc Surg. 2024 Jan 26:S0741-5214(24)00257-X. doi: 10.1016/j.jvs.2024.01.197. Online ahead of print.

Authors

Enrico Gallitto¹, Gian Luca Faggioli², Federica Campana³, Francesca Maria Feroldi³, Antonio Cappiello³, Stefania Caputo³, Rodolfo Pini², Mauro Gargiulo²

Affiliations

¹ Vascular Surgery, University of Bologna, Bologna, Italy; Vascular Surgery, IRCCS, Sant'Orsola Malpighi, Bologna, Italy. Electronic address: enrico.gallitto@gmail.com.
² Vascular Surgery, University of Bologna, Bologna, Italy; Vascular Surgery, IRCCS, Sant'Orsola Malpighi, Bologna, Italy.
³ Vascular Surgery, University of Bologna, Bologna, Italy.

PMID: 38280685
DOI: 10.1016/j.jvs.2024.01.197

Abstract

Objective: Persistent type II endoleaks (pEL2s) are not uncommon after endovascular aneurysm repair and their impact on long-term outcomes is well-documented. However, their occurrence and natural history after fenestrated/branched endografting (F/B-EVAR) for juxtarenal and pararenal aneurysms (J/P-AAAs) have been scarcely investigated. Aim of this study was to report incidence, risk factors, and natural history of pEL2 after F/B-EVAR in J/P-AAAs.

Methods: Between 2016 and 2022, all J/P-AAAs undergoing F/B-EVAR were prospectively collected and retrospectively analyzed. EL2 were assessed at the completion angiography, at 30 days and after 6 months as primary outcomes. Preoperative risk factors for pEL2, follow-up survival, freedom from reinterventions (FFR) and aneurysm shrinkage (≥5 mm) were considered as secondary outcomes.

Results: Of 132 patients, there were 88 (67%) JAAAs and 44 (33%) PAAAs. Seventeen EL2 (13%) were detected at the completion angiography and 36 (27%) at 30-day computed tomography angiography. The mean follow-up was 28 ± 23 months. Eleven (31%) EL2 sealed spontaneously within 6 months and three new cases were detected, for an overall of 28 pEL2/107 patients (26%) with available radiological follow-up of ≥6 months. Preoperative antiplatelet therapy (odds ratio, 4.7; 95% confidence interval [CI[, 1-22.1; P = .05), aneurysm thrombus volume of ≤40% and six or more patent aneurysm afferent vessels (odds ratio, 7.2; 95% CI, 1.8-29.1; P = .005) were independent risk factors for pEL2. The estimated 3-year survival was 80%, with no difference between cases with and without pEL2 (78% vs 85%; P = .08). The estimated 3-year FFR was 86%, with no difference between cases with and without pEL2 (81% vs 87%; P = .41). Four cases (3%) of EL2-related reinterventions were performed. In 65 cases (49%), aneurysm shrinkage was detected. pEL2 was an independent risk factor for absence of aneurysm shrinkage during follow-up (hazard ratio, 3.2; 95% CI, 1.2-8.3; P = .014). Patients without shrinkage had lower follow-up survival (64% vs 86% at 3-year; P = .009) and FFR (74% vs 90% at 3 years; P = .014) than patients with shrinkage.

Conclusions: PEL2 is not infrequent (26%) after F/B-EVAR for J/P-AAAs and is correlated with preoperative antiplatelet therapy, aneurysm thrombus volume of ≤40%, and six or more patent sac afferent vessels. Patients with pEL2 have a diminished aneurysm shrinkage, which is correlated with lower follow-up survival and FFR compared with patients with aneurysm shrinkage.

Keywords: Fenestrated and branched endograft; Juxta/para renal aneurysm; Persistent type 2 endoleak; Shrinkage.