Natural History of Type II Endoleaks after Endovascular Aneurysm Repair in Abdominal Aortic Aneurysm

Cho, Dong Min; Park, Keun Myoung; Yang, Shin Seok; Kim, Na Ri; Woo, Shin Young; Kim, Young Wook; Park, Kwang Bo; Park, Hong Suk; Do, Young Soo; Kim, Dong Ik

Abstract

PURPOSE
Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) has shown excellent early outcomes. However, long-term durability continues to be questioned because of endoleaks. The optimal management of type II endoleaks remains controversial because little is known about their long-term natural history. The purpose of this study was to evaluate the natural history of type II endoleaks and to study factors associated with persistent type II endoleaks.
METHODS
On a retrospective basis, we analyzed 98 patients who underwent EVAR for incidence and outcome of type II endoleaks. Patients with type II endoleaks were evaluated using computed tomography angiography or Duplex scans at one, 6 and 12 months after their EVAR, and annually thereafter to evaluate both the persistence of the endoleak and the size of the aneurysm sac.
RESULTS
Type II endoleaks were detected during the follow-up periods in 38 patients (39.8%), who underwent EVAR (mean follow-up: 23.7 months). Spontaneous sealing of type II endoleaks by 6 months after EVAR occurred in 15 patients (39.4%), meaning that there were 23 patients (60.6%) whose leaks were ongoing for more than 6 months. Four patients were treated using embolization because of an enlarging aneurysm sac.
CONCLUSION
Most type II endoleaks are transient and do not require intervention. However, particularly persistent endoleaks could lead to aneurysm enlargement and to delayed aortic rupture. We did not find a significant difference in any number of preoperative patient factors between patients with transient, persistent, or no type II endoleaks. Further studies based on independent data sets are needed to validate these results.