Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion

Katherine A. Gallagher, Reid A. Ravin, Andrew J. Meltzer, Asad Khan, Dawn M. Coleman, Ashley R. Graham, Francesco Aiello, Gautam Shrikhande, Peter H. Connolly, Rajeev Dayal, John K Karwowski

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)182-192
Number of pages11
JournalJournal of Endovascular Therapy
Volume19
Issue number2
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Endoleak
Aneurysm
Iliac Artery
Thrombosis
Arteries
Inferior Mesenteric Artery
Rupture
Angiography
Therapeutics
Transplants

Keywords

  • Abdominal aortic aneurysm
  • Coil embolization
  • Endoleak
  • Endovascular aneurysm repair
  • Inferior mesenteric artery
  • Lumbar arteries
  • Outcome analysis
  • Sac expansion
  • Type II endoleak

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Gallagher, K. A., Ravin, R. A., Meltzer, A. J., Khan, A., Coleman, D. M., Graham, A. R., ... Karwowski, J. K. (2012). Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. Journal of Endovascular Therapy, 19(2), 182-192.

Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. / Gallagher, Katherine A.; Ravin, Reid A.; Meltzer, Andrew J.; Khan, Asad; Coleman, Dawn M.; Graham, Ashley R.; Aiello, Francesco; Shrikhande, Gautam; Connolly, Peter H.; Dayal, Rajeev; Karwowski, John K.

In: Journal of Endovascular Therapy, Vol. 19, No. 2, 04.2012, p. 182-192.

Research output: Contribution to journalArticle

Gallagher, KA, Ravin, RA, Meltzer, AJ, Khan, A, Coleman, DM, Graham, AR, Aiello, F, Shrikhande, G, Connolly, PH, Dayal, R & Karwowski, JK 2012, 'Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion', Journal of Endovascular Therapy, vol. 19, no. 2, pp. 182-192.
Gallagher KA, Ravin RA, Meltzer AJ, Khan A, Coleman DM, Graham AR et al. Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. Journal of Endovascular Therapy. 2012 Apr;19(2):182-192.
Gallagher, Katherine A. ; Ravin, Reid A. ; Meltzer, Andrew J. ; Khan, Asad ; Coleman, Dawn M. ; Graham, Ashley R. ; Aiello, Francesco ; Shrikhande, Gautam ; Connolly, Peter H. ; Dayal, Rajeev ; Karwowski, John K. / Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. In: Journal of Endovascular Therapy. 2012 ; Vol. 19, No. 2. pp. 182-192.
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abstract = "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.",
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AU - Graham, Ashley R.

AU - Aiello, Francesco

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N2 - 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.

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KW - Inferior mesenteric artery

KW - Lumbar arteries

KW - Outcome analysis

KW - Sac expansion

KW - Type II endoleak

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