The Significance of Endoleaks in Thoracic Endovascular Aneurysm Repair

Background Endoleak is one of the rare complications that occur after thoracic endovascular aneurysm repair (TEVAR). The aim of this study was to assess the incidence of endoleaks and the predictive factors for their occurrence, as well as their effect on secondary interventions after TEVAR. Methods...

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Published in:	Annals of vascular surgery Vol. 25; no. 3; pp. 345 - 351
Main Authors:	Alsac, Jean-Marc, Khantalin, Ilya, Julia, Pierre, Achouh, Paul, Farahmand, Patrick, Capdevila, Clément, Isselmou, Khaled O, Fabiani, Jean-Noël
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Inc 01-04-2011
Subjects:	Aged Aged, 80 and over Aortic Aneurysm, Thoracic - diagnostic imaging Aortic Aneurysm, Thoracic - surgery Aortography - methods Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Chi-Square Distribution Endoleak - diagnostic imaging Endoleak - etiology Endoleak - therapy Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Female Humans Male Middle Aged Paris Prosthesis Design Retrospective Studies Risk Assessment Risk Factors Stents Surgery Time Factors Tomography, X-Ray Computed Treatment Outcome
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Summary:	Background Endoleak is one of the rare complications that occur after thoracic endovascular aneurysm repair (TEVAR). The aim of this study was to assess the incidence of endoleaks and the predictive factors for their occurrence, as well as their effect on secondary interventions after TEVAR. Methods Medical and radiological data of all TEVAR procedures performed between 2004 and 2008 were entered prospectively into our database and reviewed retrospectively. Primary endpoints included were the incidence and the type of endoleak, aneurysmal sac expansion, and secondary interventions. Results In all, 67 patients (18 women and 49 men; mean age, 67 ± 14 years) were treated consecutively for descending thoracic aortic aneurysms (mean diameter: 69 ± 18 mm) by TEVAR during the observed period, using 83 stent-grafts (11 Cook TX2, 31 Gore TAG, and 41 Medtronic Valiant), with a median follow-up of 27 months (range: 2-64). In 13 of 67 patients, 14 (19.4%) endoleaks were diagnosed, of which 71% (10 of 14) were type I, 29% (4 of 14) were type II, and none were type III. Ten endoleaks (71%) were diagnosed on the first postoperative computed tomographic angiography at 1 month, and the other four (29%) developed later on. Predictive factors for endoleaks on univariate analysis included age ( p = 0.04), length of the proximal neck immediately after the left subclavian artery ( p = 0.04), the fusiform morphology of the descending thoracic aortic aneurysms ( p = 0.04), and the type of stent-graft used ( p = 0.02). Eight of the 10 type I endoleaks (80%) were successfully treated by endovascular means, using proximal cuffs ( n = 5) or distal extensions ( n = 3). None of type II endoleaks were treated by secondary intervention. The six endoleaks treated conservatively were all associated with a significant mean increase of their aneurysmal sac (+3.2 ± 2.6 mm) during follow-up. No secondary conversion to open surgery was performed to treat an endoleak. Conclusions On the basis of the study, it seems as if endoleaks are detected in one of the five patients treated with TEVAR during follow-up period, particularly if they are old with a proximal and fusiform aneurysm. Short- and mid-term follow-up suggest that most type I endoleaks can successfully be treated by endovascular techniques and that type II endoleaks treated conservatively require a close radiological monitoring.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0890-5096 1615-5947
DOI:	10.1016/j.avsg.2010.08.002