Document Detail

Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion.
MedLine Citation:
PMID:  22545883     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To examine the outcomes following interventions for type II endoleaks in patients with aneurysm sac expansion after endovascular aneurysm repair (EVAR).
METHODS: A retrospective review was conducted of all patients who underwent treatment for type II endoleak from July 2001 to September 2010 in a single center. In this time period, 29 (4.7%) patients (22 men; mean age 78.6 years, range 54-87) were identified as having a type II endoleak and enlargement of the aneurysm sac, meeting the criterion for treatment. All patients had at least one attempted percutaneous intervention. Patients were followed both clinically and radiographically, with computed tomographic angiography every 3 to 12 months, over a follow-up period that ranged from 1 to 10 years (mean 3.5).
RESULTS: Forty-eight interventions were performed on the 29 patients. Of these, 15 (56%) patients underwent multiple (2-4) procedures. Of the 11 endoleaks with an isolated inferior mesenteric artery identified as the source, initial success for transarterial embolization at 2 years was 72%, with 2 of the failures having successful secondary interventions. For the 18 endoleaks with a lumbar source, the success of the initial intervention was 17% at 2 years; repeated embolization attempts produced a 40% secondary success rate. Seven (24%) patients had continued endoleak despite multiple treatment attempts; 3 ultimately required elective aortic graft explantation. There were no ruptures or deaths during the study period. In a comparison of type II endoleak patients who had stable aneurysm sacs and those who had persistent sac expansion, the only significant differences in preoperative anatomical characteristics were a lower prevalence of mural thrombus (p = 0.036) and longer right iliac arteries (p = 0.012) in the group with sac expansion. Independent predictors of type II endoleak were mural thrombus (p<0.001), patent lumbar arteries (p = 0.004), aneurysm length (p = 0.011), and iliac artery length (p = 0.004).
CONCLUSION: This study demonstrates that most patients require multiple reinterventions to treat type II endoleaks; specifically, lumbar artery embolization carries a low midterm success rate.
Katherine A Gallagher; Reid A Ravin; Andrew J Meltzer; Muhammad A Khan; Asad Khan; Dawn M Coleman; Ashley R Graham; Francesco Aiello; Gautam Shrikhande; Peter H Connolly; Rajeev Dayal; John K Karwowski
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  19     ISSN:  1545-1550     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-05-01     Completed Date:  2012-08-27     Revised Date:  2012-09-11    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  182-92     Citation Subset:  IM    
University of Michigan Hospital, Ann Arbor, Michigan, USA.
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MeSH Terms
Aged, 80 and over
Aortic Aneurysm, Abdominal / radiography,  surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / adverse effects*,  instrumentation
Device Removal
Embolization, Therapeutic*
Endoleak / etiology,  radiography,  surgery,  therapy*
Endovascular Procedures / adverse effects*,  instrumentation
Kaplan-Meier Estimate
Middle Aged
Multivariate Analysis
New York City
Predictive Value of Tests
Prosthesis Design
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Erratum In:
J Endovasc Ther. 2012 Jun;19(3):A6
Note: Khad, Asad [corrected to Khan, Muhammad A]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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