Outcomes of Type II Endoleak Management After Abdominal Aortic Aneurysm Repair: A Retrospective 18-year Cohort

O. Murat

Purpose: Single institution retrospective study to assess technical and clinical outcomes of interventional management of Type 2 Endoleak (T2EL) after abdominal endovascular aneurysm repair (EVAR).

Materials and Methods: Between 2004 and 2022, all patients with T2EL were identified through medical chart review and included in the study cohort. Patient demographics, embolization technique/material type, technical success and clinical success were evaluated. Clinical success was defined by both sac size decrease/stability (2 mm/year) for greater than 6 months. Patients with CT follow up for a minimum of 1 month were included in the study, and overall available follow up ranged between 1 month to 17 years. Major adverse events were reviewed.

Results: 49 patients (36 male, 13 female) were identified with T2EL on follow up CT imaging with either interval aneurysm growth or aortic aneurysm > 5 cm. 16 out of 49 patients had stable aneurysms and did not require intervention. 15 out of 42 transarterial procedures were excluded from the analysis as 13 were diagnostic/no intervention was performed, and two cases were secondary to type IA endoleaks found intraoperatively.Technical success in transarterial (TA) and direct sac puncture (DSP) groups were found to be 70% (n = 19/27) vs 90% (n = 26/29), respectively. Technical success for transcaval sac puncture (TCSP) was 100%. A higher rate of sac size stability or regression was observed after DSP vs TA embolization, 92% (n = 24/26) vs 69% (n = 9/13). Change in average sac diameter after TA and DSP embolization was 0.4 and -1.4 mm, respectively (P=0.29).  The average freedom from sac size enlargement after TA and DSP was 522 vs 730 days (P=.19). Major adverse event from TA embolization included nontarget embolization to the lower extremity requiring pharmacomechanical thrombectomy (n = 1/27, 3.7%). Major adverse event from DSP included retroperitoneal hemorrhage requiring embolization (n = 1/29, 3.4%). No procedure-related mortality was observed.

Conclusions: In our relatively small patient group overall success for sac size control for T2EL was achieved better with DSP compared to TA approach. Both TA and DSP embolization are deemed safe and have similar procedure-related major adverse event rates.