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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
The Journal of Cardiovascular Surgery 2015 Jul 29
Persistent type II endoleak after EVAR: the predictive value of the AAA thrombus volume
Gallitto E. 1, Gargiulo M. 1, Mascoli C. 1, Freyrie A. 1, De Matteis M. 2, Serra C. 3, Bianchini Massoni C. 1, Faggioli G. L. 1, Stella A. 1 ✉
1 Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy;
2 Radiology, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy;
3 Ultrasound Unit, Department of Internal Medicine and Gastroenterology, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy
OBJECTIVE: Persistent type II endoleaks (ELIIp, ≥6months) after an endovascular aneurysm repair (EVAR) can be associated with adverse outcomes. The aims of this study are the evaluation of the incidence of ELIIp, their pre-operative morphological predictive features (PMF) and the post-EVAR abdominal aortic aneurysm (AAA) evolution in the presence of ELIIp.
METHODS: Patients underwent EVAR between 2008 and 2010 were prospectively collected. Cases with ELIIp (group A: AG) were identified. A control group without ELIIp (group B: BG), homogeneous for clinical characteristics, follow-up timing and methods (CTA and/or CEUS at 6,12months and yearly thereafter) was retrospectively selected. The PMF evaluated by computedtomography-angiography (CTA) were: AAA-diameter, number and diameter of AAA efferent patent vessels (EPV), AAA-total volume (TV), AAA-thrombus volume (THV) and TV/THV rate (%VR). Volumes were calculated by the dedicated vessels analysis software. AG and BG were compared. The primary endpoint was to evaluate the incidence of ELIIp. Secondary endpoints were to analyze the relation between PMF and ELIIp and to assess the post-EVAR AAA-evolution in the presence of ELIIp.
RESULTS: Between 2008 and 2010, 200 patients underwent EVAR to treat AAA electively. An ELIIp was detected in 35cases (17.5%)(AG). Twenty-seven patients (13.5%) were included in BG. An overall of 62 patients (GA+GB) were analyzed. The mean pre-operative AAA diameter and EPV were 58±11.6mm and 5.5±1.8mm, respectively. The mean TV and THV were 187±111.5cc e 82±75cc, respectively. The median %VR was 42.3%. ELIIp was correlated to EPV ≥ 6(χ2, p=.015) e %VR <40% (Logistic regression, p=.032). The mean follow-up was 22±9months. Seven (20%) ELIIp spontaneously sealed and 6 (17%) required re-interventions (2conversions to OR). There were not PMF associated to ELIIp evolution and AAA growth post-EVAR.
CONCLUSIONS: ELIIp is a not rare complication and it could require re-interventions. Our data suggest that VEP≥6 or %VT<40% are risk factors for ELIIp. No PMF was able to predict the ELIIp evolution. The relative high rate of re-interventions, could suggest the need of adjunctive/preventing primary procedures in patients at high-risk for ELIIp.