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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2014 Dicembre;21(4):205-8
Treatment and follow-up of type II endoleak: a four-year experience on 129 patients
Varetto G., Quaglino S., Benintende E., Castagno C., Garneri P., Bertoldo U., Rispoli P.
Division of Vascular Surgery, Department of Surgical Sciences, Città della Salute e della Scienza Molinette Hospital, University of Turin, Turin, Italy
AIM: The purpose of this manuscript was to bring our experience on EVAR surveillance and endoleak management in the last 4 years.
METHODS: We reviewed every patient undergoing EVAR between January 2009 and January 2013. In the presence of a type II endoleak (T2EL) with a stable or negligible enlarging sac (<0.5 cm) we had a conservative approach. We treated every patient with an enlarging sac >0.5 cm based on the T2EL characteristics. We defined clinical success as shrinkage or stabilization of the aneurysm sac and recorded every complications. Median follow-up time was 29.6 months (range 6-41 months).
RESULTS: We identified 22 type II endoleaks on a series of 129 EVAR. Fourteen embolization attempts have been performed on 13 patients. In 9 cases (68%) the endoleak was successfully solved. No aneurysm rupture occurred in our population. Endoleak originating from hypogastric arteries was the worst predictive factor for aneurysm sac growth. Technical success rate was higher for lumbar artery embolization (100%) if compared to lumbar arteries (60%) or inferior mesenteric arteries (IMA) (50%). Secondary procedures was performed on 2 patients (15%).
CONCLUSION: T2EL embolization procedures are often inconclusive and their efficacy in preventing aneurysm rupture has to be proved. An accurate selection of the patients based on the vessel feeding the sac and the aneurysm growth rate is mandatory to achieve clinical success and avoid serious complications.