Risk Factors Analysis of Type Ⅱ Endoleak after Endovascular Aneurysm Repair_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HUANGBin , WUZhou-peng ,  ZHAOJi-chun , YUANDing , YANGYi , XIONGFei , ZENGGuo-jun , CHENXi-yang

Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

ZHAOJi-chun, Email: zhaojc3@126.com

Keywords：

Type Ⅱ endoleak; Lumbar artery; Iliac artery; Influencing factor; Endovascular aneurysm repair; Abdominal aortic aneurysm

DOI：

10.7507/1007-9424.20140161

Video：

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Objective To discuss the risk factors of type Ⅱ endoleak after endovascular aneurysm repair(EVAR). Methods The clinical data of 197 cases of abdominal aortic aneurysm who underwent EVAR in our hospital from Jan. 2006 to Mar. 2011 were analyzed retrospectively, and risk factors of type Ⅱ endoleak were explored by logistic regression. Results Of the 197 cases, 18 cases suffered from type Ⅱ endoleak. Result of logistic regression showed that the risk of type Ⅱ endoleak increased per 1 of the increase of lumbar artery number(OR=1.822, P=0.010) and per 1 mm of the increase of lumbar artery diameter(OR=1.256, P=0.040). All of the cases were followed up for 1-36 months(median value of 16.8 months). Only 1 case was intervened by inferior mesenteric artery embolism for the growth rate larger than 5 mm during half a year, who was not found growth of diameter after the embolism. The type Ⅱ endoleaks of other 17 cases closed ultimately or keeping stable. Conclusions Type Ⅱ endoleak after EVAR is affected by the number and diameter of lumbar artery. Persistent type Ⅱ endoleak without enlargement of diameter of aneurysm sac needs to beclosely followed-up instead of re-intervention.

Citation： HUANGBin, WUZhou-peng, ZHAOJi-chun, YUANDing, YANGYi, XIONGFei, ZENGGuo-jun, CHENXi-yang. Risk Factors Analysis of Type Ⅱ Endoleak after Endovascular Aneurysm Repair. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(6): 663-668. doi: 10.7507/1007-9424.20140161 Copy

1.	Makaroun M, Zajko A, Sugimoto H, et al.Fate of endoleaks after endoluminal repair of abdominal aortic aneurysms with the EVT device[J].Eur J Vasc Endovasc Surg, 1999, 18(3):185-190.
2.	White GH, Yu W, May J, et al.Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms:classification, incidence, diagnosis, and management[J].J Endovasc Surg, 1997, 4(2):152-168.
3.	Walker SR, Halliday K, Yusuf SW, et al.A study on the patency of the inferior mesenteric and lumbar arteries in the incidence of endoleak following endovascular repair of infra-renal aortic aneurysms[J].Clin Radiol, 1998, 53(8):593-595.
4.	van Marrewijk CJ, Fransen G, Laheij RJ, et al.Is a typeⅡ endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up[J].Eur J Vasc Endovasc Surg, 2004, 27(2):128-137.
5.	Sheehan MK, Ouriel K, Greenberg R, et al.Are type Ⅱ endoleaks after endovascular aneurysm repair endograft dependent?[J].J Vasc Surg, 2006, 43(4):657-661.
6.	Uflacker R, Brothers T.Filling of the aneurysmal sac with DEACglucosamine in an animal model of abdominal aortic aneurysm following stent-graft repair[J].J Cardiovasc Surg (Torino), 2006, 47(4):425-436.
7.	Chaikof EL, Blankensteijn JD, Harris PL, et al.Reporting standards for endovascular aortic aneurysm repair[J].J Vasc Surg, 2002, 35(5):1048-1060.
8.	Steinmetz E, Rubin BG, Sanchez LA, et al.Type Ⅱ endoleak after endovascular abdominal aortic aneurysm repair:a conservative approach with selective intervention is safe and cost-effective[J].J Vasc Surg, 2004, 39(2):306-313.
9.	Rubin BG, Marine L, Parodi JC.An algorithm for diagnosis and treatment of type Ⅱ endoleaks and endotension after endovascular aneurysm repair[J].Perspect Vasc Surg Endovasc Ther, 2005, 17(2):167-172.
10.	Jonker FH, Aruny J, Muhs BE.Management of typeⅡ endoleaks:preoperative versus postoperative versus expectant management[J].Semin Vasc Surg, 2009, 22(3):165-171.
11.	Baum RA, Cope C, Fairman RM, et al.Translumbar embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms[J].J Vasc Interv Radiol, 2001, 12(1):111-116.
12.	Baum RA, Stavropoulos SW, Fairman RM, et al.Endoleaks after endovascular repair of abdominal aortic aneurysms[J].J Vasc Interv Radiol, 2003, 14(9):1111-1117.
13.	Schurink GW, Aarts NJ, Wilde J, et al.Endoleakage after stentgraft treatment of abdominal aneurysm:implications on pressure and imaging-an in vitro study[J].J Vasc Surg, 1998, 28(2):234-241.
14.	Jones JE, Atkins MD, Brewster DC, et al.Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes[J].J Vasc Surg, 2007, 46(1):1-8.
15.	Nolz R, Teufelsbauer H, Asenbaum U, et al.Type Ⅱ endoleaks after endovascular repair of abdominal aortic aneurysms:fate of the aneurysm sac and neck changes during long-term follow-up[J].J Endovasc Ther, 2012, 19(2):193-199.
16.	Haulon S, Tyazi A, Willoteaux S, et al.Embolization of type Ⅱ endoleaks after aortic stent-graft implantation:technique and immediate results[J].J Vasc Surg, 2001, 34(4):600-605.
17.	Arko FR, Filis KA, Siedel SA, et al.Intrasac flow velocities predict sealing of type Ⅱ endoleaks after endovascular abdominal aortic aneurysm repair[J].J Vasc Surg, 2003, 37(1):8-15.
18.	Haulon S, Devos P, Willoteaux S, et al.Risk factors of early and late complications in patients undergoing endovascular aneurysm repair[J].Eur J Vasc Endovasc Surg, 2003, 25(2):118-124.
19.	Görich J, Rilinger N, Sokiranski R, et al.Endoleaks after endovascular repair of aortic aneurysm:are they predictable? Initial results[J].Radiology, 2001, 218(2):477-480.
20.	Baum RA, Carpenter JP, Golden MA, et al.Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms:comparison of transarterial and translumbar techniques[J].J Vasc Surg, 2002, 35(1):23-29.
21.	Gallagher KA, Ravin RA, Meltzer AJ, et al.Midterm outcomes after treatment of type Ⅱ endoleaks associated with aneurysm sac expansion[J].J Endovasc Ther, 2012, 19(2):182-192.
22.	Mclafferty RB, Mccrary BS, Mattos MA, et al.The use of color-flow duplex scan for the detection of endoleaks[J].J Vasc Surg, 2002, 36(1):100-104.
23.	Sarac TP, Gibbons C, Vargas L, et al.Long-term follow-up of type Ⅱ endoleak embolization reveals the need for close surveillance[J].J Vasc Surg, 2012, 55(1):33-40.
24.	Shimohira M, Hashizume T, Suzuki Y, et al.Triaxial system for embolization of type Ⅱ endoleak after endovascular aneurysm repair[J].J Endovasc Ther, 2013, 20(2):200-204.
25.	Aziz A, Menias CO, Sanchez LA, et al.Outcomes of percutaneous endovascular intervention for type Ⅱ endoleak with aneurysm expansion[J].J Vasc Surg, 2012, 55(5):1263-1267.
26.	van Bindsbergen L, Braak SJ, van Strijen MJ, et al.Type Ⅱ endoleak embolization after endovascular abdominal aortic aneurysm repair with use of real-time three-dimensional fluoroscopic needle guidance[J].J Vasc Interv Radiol, 2010, 21(9):1443-1447.
27.	Muthu C, Maani J, Plank LD, et al.Strategies to reduce the rate of type Ⅱ endoleaks:routine intraoperative embolization of the inferior mesenteric artery and thrombin injection into the aneurysm sac[J].J Endovasc Ther, 2007, 14(5):661-668.
28.	Stavropoulos SW, Marin H, Fairman RM, et al.Recurrent endoleak detection and measurement of aneurysm size with CTA after coil embolization of endoleaks[J].J Vasc Interv Radiol, 2005, 16(10):1313-1317.
29.	Mcwilliams RG, Martin J, White D, et al.Detection of endoleak with enhanced ultrasound imaging:comparison with biphasic computed tomography[J].J Endovasc Ther, 2002, 9(2):170-179.
30.	Keedy AW, Yeh BM, Kohr JR, et al.Evaluation of potential outcome predictors in type Ⅱ endoleak:a retrospective study with CT angiography feature analysis[J].AJR Am J Roentgenol, 2011, 197(1):234-240.
31.	Parent FN, Meier GH, Godziachvili V, et al.The incidence and natural history of type Ⅰ and Ⅱ endoleak:a 5-year follow-up assessment with color duplex ultrasound scan[J].J Vasc Surg, 2002, 35(3):474-481.
32.	Schurink GW, Aarts NJ, Van Baalen JM, et al.Experimental study of the influence of endoleak size on pressure in the aneurysm sac and the consequences of thrombosis[J].Br J Surg, 2000, 87(1):71-78.
33.	Karthikesalingam A, Thrumurthy SG, Jackson D, et al.Current evidence is insufficient to define an optimal threshold for intervention in isolated type Ⅱ endoleak after endovascular aneurysm repair[J].J Endovasc Ther, 2012, 19(2):200-208.

1. Makaroun M, Zajko A, Sugimoto H, et al.Fate of endoleaks after endoluminal repair of abdominal aortic aneurysms with the EVT device[J].Eur J Vasc Endovasc Surg, 1999, 18(3):185-190.
2. White GH, Yu W, May J, et al.Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms:classification, incidence, diagnosis, and management[J].J Endovasc Surg, 1997, 4(2):152-168.
3. Walker SR, Halliday K, Yusuf SW, et al.A study on the patency of the inferior mesenteric and lumbar arteries in the incidence of endoleak following endovascular repair of infra-renal aortic aneurysms[J].Clin Radiol, 1998, 53(8):593-595.
4. van Marrewijk CJ, Fransen G, Laheij RJ, et al.Is a typeⅡ endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up[J].Eur J Vasc Endovasc Surg, 2004, 27(2):128-137.
5. Sheehan MK, Ouriel K, Greenberg R, et al.Are type Ⅱ endoleaks after endovascular aneurysm repair endograft dependent?[J].J Vasc Surg, 2006, 43(4):657-661.
6. Uflacker R, Brothers T.Filling of the aneurysmal sac with DEACglucosamine in an animal model of abdominal aortic aneurysm following stent-graft repair[J].J Cardiovasc Surg (Torino), 2006, 47(4):425-436.
7. Chaikof EL, Blankensteijn JD, Harris PL, et al.Reporting standards for endovascular aortic aneurysm repair[J].J Vasc Surg, 2002, 35(5):1048-1060.
8. Steinmetz E, Rubin BG, Sanchez LA, et al.Type Ⅱ endoleak after endovascular abdominal aortic aneurysm repair:a conservative approach with selective intervention is safe and cost-effective[J].J Vasc Surg, 2004, 39(2):306-313.
9. Rubin BG, Marine L, Parodi JC.An algorithm for diagnosis and treatment of type Ⅱ endoleaks and endotension after endovascular aneurysm repair[J].Perspect Vasc Surg Endovasc Ther, 2005, 17(2):167-172.
10. Jonker FH, Aruny J, Muhs BE.Management of typeⅡ endoleaks:preoperative versus postoperative versus expectant management[J].Semin Vasc Surg, 2009, 22(3):165-171.
11. Baum RA, Cope C, Fairman RM, et al.Translumbar embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms[J].J Vasc Interv Radiol, 2001, 12(1):111-116.
12. Baum RA, Stavropoulos SW, Fairman RM, et al.Endoleaks after endovascular repair of abdominal aortic aneurysms[J].J Vasc Interv Radiol, 2003, 14(9):1111-1117.
13. Schurink GW, Aarts NJ, Wilde J, et al.Endoleakage after stentgraft treatment of abdominal aneurysm:implications on pressure and imaging-an in vitro study[J].J Vasc Surg, 1998, 28(2):234-241.
14. Jones JE, Atkins MD, Brewster DC, et al.Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes[J].J Vasc Surg, 2007, 46(1):1-8.
15. Nolz R, Teufelsbauer H, Asenbaum U, et al.Type Ⅱ endoleaks after endovascular repair of abdominal aortic aneurysms:fate of the aneurysm sac and neck changes during long-term follow-up[J].J Endovasc Ther, 2012, 19(2):193-199.
16. Haulon S, Tyazi A, Willoteaux S, et al.Embolization of type Ⅱ endoleaks after aortic stent-graft implantation:technique and immediate results[J].J Vasc Surg, 2001, 34(4):600-605.
17. Arko FR, Filis KA, Siedel SA, et al.Intrasac flow velocities predict sealing of type Ⅱ endoleaks after endovascular abdominal aortic aneurysm repair[J].J Vasc Surg, 2003, 37(1):8-15.
18. Haulon S, Devos P, Willoteaux S, et al.Risk factors of early and late complications in patients undergoing endovascular aneurysm repair[J].Eur J Vasc Endovasc Surg, 2003, 25(2):118-124.
19. Görich J, Rilinger N, Sokiranski R, et al.Endoleaks after endovascular repair of aortic aneurysm:are they predictable? Initial results[J].Radiology, 2001, 218(2):477-480.
20. Baum RA, Carpenter JP, Golden MA, et al.Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms:comparison of transarterial and translumbar techniques[J].J Vasc Surg, 2002, 35(1):23-29.
21. Gallagher KA, Ravin RA, Meltzer AJ, et al.Midterm outcomes after treatment of type Ⅱ endoleaks associated with aneurysm sac expansion[J].J Endovasc Ther, 2012, 19(2):182-192.
22. Mclafferty RB, Mccrary BS, Mattos MA, et al.The use of color-flow duplex scan for the detection of endoleaks[J].J Vasc Surg, 2002, 36(1):100-104.
23. Sarac TP, Gibbons C, Vargas L, et al.Long-term follow-up of type Ⅱ endoleak embolization reveals the need for close surveillance[J].J Vasc Surg, 2012, 55(1):33-40.
24. Shimohira M, Hashizume T, Suzuki Y, et al.Triaxial system for embolization of type Ⅱ endoleak after endovascular aneurysm repair[J].J Endovasc Ther, 2013, 20(2):200-204.
25. Aziz A, Menias CO, Sanchez LA, et al.Outcomes of percutaneous endovascular intervention for type Ⅱ endoleak with aneurysm expansion[J].J Vasc Surg, 2012, 55(5):1263-1267.
26. van Bindsbergen L, Braak SJ, van Strijen MJ, et al.Type Ⅱ endoleak embolization after endovascular abdominal aortic aneurysm repair with use of real-time three-dimensional fluoroscopic needle guidance[J].J Vasc Interv Radiol, 2010, 21(9):1443-1447.
27. Muthu C, Maani J, Plank LD, et al.Strategies to reduce the rate of type Ⅱ endoleaks:routine intraoperative embolization of the inferior mesenteric artery and thrombin injection into the aneurysm sac[J].J Endovasc Ther, 2007, 14(5):661-668.
28. Stavropoulos SW, Marin H, Fairman RM, et al.Recurrent endoleak detection and measurement of aneurysm size with CTA after coil embolization of endoleaks[J].J Vasc Interv Radiol, 2005, 16(10):1313-1317.
29. Mcwilliams RG, Martin J, White D, et al.Detection of endoleak with enhanced ultrasound imaging:comparison with biphasic computed tomography[J].J Endovasc Ther, 2002, 9(2):170-179.
30. Keedy AW, Yeh BM, Kohr JR, et al.Evaluation of potential outcome predictors in type Ⅱ endoleak:a retrospective study with CT angiography feature analysis[J].AJR Am J Roentgenol, 2011, 197(1):234-240.
31. Parent FN, Meier GH, Godziachvili V, et al.The incidence and natural history of type Ⅰ and Ⅱ endoleak:a 5-year follow-up assessment with color duplex ultrasound scan[J].J Vasc Surg, 2002, 35(3):474-481.
32. Schurink GW, Aarts NJ, Van Baalen JM, et al.Experimental study of the influence of endoleak size on pressure in the aneurysm sac and the consequences of thrombosis[J].Br J Surg, 2000, 87(1):71-78.
33. Karthikesalingam A, Thrumurthy SG, Jackson D, et al.Current evidence is insufficient to define an optimal threshold for intervention in isolated type Ⅱ endoleak after endovascular aneurysm repair[J].J Endovasc Ther, 2012, 19(2):200-208.

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Risk Factors Analysis of Type Ⅱ Endoleak after Endovascular Aneurysm Repair

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