Original title: Outcomes of persistent intraoperativa Type Ia endoleak after Standard endovascular aneurysm repair. Reference: Alistair Millen, et al. J. Vasc. Surg 2015;61:1185-91

The purpose of Endovascular Aneurysm Repair (EVAR) in the infrarenal abdominal aortic aneurysms (IAAA) is to prevent growth and rupture. Inadequate proximal seal by the stent favors the presence of leak type 1A that preserves sack pressurization and increases complications and mortality. Implant patients receiving EVAR for IAAA were analyzed, excluding those presenting complex aneurysms. 209 patients for analysis were included of which 44 (21%) had leak type 1A during control angiography post implant.

Balloon remodeling was performed, implantation of P4014 stent or aortic cuff leak type 1A still persisting in 33 patients. In the previous angiography IAAA diameter was 63 mm, neck length 21 mm and neck diameter 30 mm. Stents used were Medtronic stent graft, Gore stent graft and Zenith stent graft. In the first control scan to an average of 33 days (3-61 days) resolution of the leak was observed in 31 patients (94%) without requiring further intervention.

At follow-up at 27 months five unrelated and no related deaths were observed. In subsequent control scans 18 patients showed regression, in 12 there was no change and in 2 the size of the sack increased, but it was decided not to make a new intervention. 

Conclusion

Despite the maneuvers during the procedure, persistent leak type 1A is relatively common. This study indicates that is present in an important group of patients. More research is required to determine the natural course and leak type 1A management.

Editorial comment

The presence of leak type 1A maneuvers after intra-procedure is high, but its development is good since they are often sealed commonly together with aneurysm diameter reduction.

If sealed is not achieved, it generates a significant problem relating to a pressure increase. There are a variety of endovascular strategies to solve it (balloon remodeling, cuff implantation or Palmaz stent, coils or Onyx embolization or biological cement), leaving surgical procedures such as aortic banding or conversion to conventional surgery as a last alternative.

Courtesy of Carlos Fava MD.
Interventional Cardiologist
Favaloro Foundation – Buenos Aires

Dr. Carlos Fava