Original Title: Risk factors and consequences of persistent type II endoleaks. Reference: Ruby C. Lo et al. J Vasc Surg 2016;63:895-901
The presence of type II endoleaks is infrequent (1%-10%) and most cases resolve spontaneously at 12 months. When they don’t, there is still controversy as to whether they may be associated to aneurysm diameter increase or to aneurysm rupture requiring intervention or conversion to surgery.
2367 patients receiving endovascular aneurysm repair were analyzed; 1977 (84%) did not present leaks or presented transient endoleaks, and 390 patients presented persistent endoleaks at follow up.
There were no differences in anatomical characteristics of aneurysms between those with endoleaks and those without.
There were no difference in device type, but there was a higher rate of type II endoleaks with coil embolization to one or both hypogastric arteries (12% vs. 8% p=0.02) and also a higher rate of endoleaks when using extensions (12% vs. 8% (p=0.008).
Follow up was at mean 463 days and the presence of type II endoleaks was a predictor of reintervention (OR 15.3; CI 95% 9.7-24.3; p<0.01) but not of mortality (OR 1.1; CI 95% 0.9-1.6; p=0.477).
Conclusion
The presence of type II endoleaks in patients undergoing endovascular aneurysm repair to treat an abdominal aortic aneurysm is more frequent when there is coil embolization to one or both hypogastric arteries and when using extensions. Type II endoleak persistence is associated to an increase in reintervention but not to aneurysm rupture or mortality. This reinforces the need to control patients with type II endoleak persistence.
Editorial Comment
Though retrospective, and therefore weak, this is the largest study on type II endoleaks. Even so, it seems clear that type II endoleaks are not associated with hard events such as death or rupture.
Courtesy of Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Buenos Aires