Spontaneous Delayed Sealing in Selected Patients with a Primary Type-Ia Endoleak After Endovascular Aneurysm Repair

• Published in: European journal of vascular and endovascular surgery Vol. 48; no. 1; pp. 53 - 59
• Main Authors: Bastos Gonçalves, F, Verhagen, H.J.M, Vasanthananthan, K, Zandvoort, H.J.A, Moll, F.L, van Herwaarden, J.A
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2014
• Subjects: Abdominal aortic aneurysm; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Endoleak; Endoleak - diagnosis; Endoleak - diagnostic imaging; Endoleak - etiology; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular techniques; Female; Humans; Male; Multidetector Computed Tomography; Netherlands; Prosthesis Design; Recurrence; Remission, Spontaneous; Retreatment; Retrospective Studies; Secondary intervention; Stents; Surgery; Time Factors; Endovascular techniques; Secondary intervention; Endoleak; Abdominal aortic aneurysm
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2014.01.018

Objective Direct additional therapy is advised for type-Ia endoleaks detected on completion angiography after endovascular aneurysm repair (EVAR). Additional intraoperative endovascular procedures are, however, often challenging or not possible, and direct open conversion is unattractive. The results of a selective, conservative strategy for patients with primary type-Ia endoleak has been analysed. Methods This was a retrospective, single-centre study (UMC, Utrecht, NL). From 2004 to 2008, all patients with a primary type-Ia endoleak and suitable anatomy for EVAR, stentgraft oversizing ≥15%, and optimal deployment were included. Complications during follow-up were studied and all sequential CTA scans were reviewed. These were compared with the remaining patients, treated during the same period. Results Fifteen patients were included (14 male, median age 77, range 67–85) with a median aneurysm diameter of 60 mm (48–80), an aneurysm neck diameter of 26 mm (21–32), a neck length of 29 mm (11–39), and infrarenal angulation of 49° (31–90). One patient suffered rupture 2 days after EVAR – leading to the only AAA-related death. Eight of the 15 type-Ia endoleaks disappeared spontaneously on the first postoperative CTA, obtained within 1 week of EVAR. On the second postoperative CTA, obtained a median of 5 months (1–12) after EVAR, all remaining endoleaks had sealed. One recurrence occurred at 4.85 years. During a median follow-up of 3.3 years, there were five secondary interventions. Compared with controls, there were more secondary (or recurrent) type-1a endoleaks (13% vs. 4%), endograft migrations (13% vs. 3%), sac growths (33% vs. 16%), and secondary interventions (33% vs. 23%). None of these differences however, were statistically significant. Conclusions All but one of the primary type-Ia endoleaks sealed spontaneously. Until sealing, the risk of rupture persisted, but subsequently only one recurrence of type-Ia endoleak was seen. In selected patients, a conservative approach for primary type-Ia endoleaks may be justified.