This work emphasizes the need to be conservative with type 2 endoleaks, and the need for long-term prospective information to learn about the advantages of intervention.
The presence of type 2 endoleaks is associated with reintervention, as it was historically assumed that they increase the risk of sac rupture. However, this new research, published in Eur J Vasc Endovasc Surg, suggests that there are no differences in mortality after 10 years of follow-up among those who underwent a reintervention and those treated conservatively.
This retrospective cohort from several centers in the Netherlands included all patients who underwent endovascular repair of an infrarenal abdominal aortic aneurysm between 2007 and 2012.
The primary endpoint was survival of patients with type 2 endoleak vs. patients without endoleak. Secondary endpoints included sac growth, aneurysm rupture, and reintervention.
About 2018 patients were included, with a mean follow-up of >5 years and, in some cases, >10 years.
No differences were observed in terms of mortality between patients with and without endoleaks (n = 388 and n = 1630, respectively; p = 0.54). More importantly, among the 388 patients with endoleak, no differences were observed between patients who underwent reintervention and those treated conservatively.
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Sac growth was detected in 89 patients with endoleak, which resulted in treatment for half the group only (n = 44, 49.8%).
In virtually all patients who received type 2 endoleak treatment for sac growth (n = 41, 93.1%), the sac continued to grow and was left without further intervention.
In 4 out of 388 patients with type 2 endoleak, the sac ruptured. According to the multivariate analysis, mortality predictors were age, surgical risk, and maximum iliac diameter. Endoleak presence, sac growth, and endoleak intervention did not predict mortality.
Conclusion
The long-term survival of patients with type 2 endoleak is similar to that of patients without it. Furthermore, no benefit was observed in reintervened patients vs. those treated conservatively. A prospective study is needed to define the prognosis of type 2 endoleaks and their need of intervention.
Original Title: Type 2 Endoleak With or Without Intervention and Survival After Endovascular Aneurysm Repair.
Reference: Sana Mulay et al. Eur J Vasc Endovasc Surg. 2021 May;61(5):779-786. doi: 10.1016/j.ejvs.2021.01.017.
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