Clinical significance of type II endoleaks after thoracic endovascular aortic repair

• Published in: Journal of vascular surgery Vol. 58; no. 3; pp. 643 - 650
• Main Authors: Bischoff, Moritz S., MD, Geisbüsch, Philipp, MD, Kotelis, Drosos, MD, Müller-Eschner, Matthias, MD, Hyhlik-Dürr, Alexander, MD, Böckler, Dittmar, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.09.2013
• Subjects: Adult; Aged; Aged, 80 and over; Aorta, Thoracic - surgery; Aortic Diseases - mortality; Aortic Diseases - surgery; Aortography - methods; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - mortality; Endoleak - therapy; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Germany; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Retrospective Studies; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2013.03.026

Background To evaluate the clinical significance of type II endoleaks (ELII) after thoracic endovascular aortic repair (TEVAR). Methods From January 1997 to June 2012, a total of 344 patients received TEVAR in our institution. ELII was diagnosed in 30 patients (8.7%; 13 males; median age: 65 years, range: 24 to 84 years), representing the study population of this retrospective, single-center analysis. Mean follow-up was 29.5 months (range, 8 months to 9.5 years). Results Primary ELII was observed in all but two cases (28/30; 93.3%). The most common sources of ELII were the left subclavian artery (LSA; 13/30; 43.3%) and intercostal/bronchial vessels (13/30; 43.3%), followed by visceral arteries (4/30; 13.4%). Overall mortality was 33.3% (10/30). ELII-related death (secondary rupture) was observed in 20% (2/10). Reintervention (RI) procedures for ELII were performed in 9 of 30 patients (30.0%); 5 of 9 (55.6%) in cases with ELII via the LSA. Indications for RI were diameter expansion in five and extensive leakage in four cases. Treatment was successful in five patients (55.6%) but failed in four cases (44.4%). In 12 of 21 (57.1%) untreated patients, ELII sealed during follow-up. In conservatively treated patients, an increase in aortic diameter has been only observed in a patient with secondary ELII. Conclusions The results presented herein suggest that the clinical impact of ELII after TEVAR must not be underestimated. Albeit a transient finding in most cases, ELII is associated with a relevant RI rate, particularly in cases involving the LSA. RI seems indicated in patients with increasing aortic diameter and/or extensive leakage. Careful surveillance of all patients with ELII is recommended.