03:36 PM Abstract No. 27 Factors influencing clinical success following the endovascular management of type 2 endoleaks

Abstract

To study outcomes and factors that predict success of transarterial (TA) and translumbar (TL) embolization of type 2 endoleaks following endovascular aortic aneurysm repair (EVAR). One-hundred-thirty patients (mean age, 71.4y; range, 53-95) with type 2 endoleaks referred for TA or TL embolization from August 2003 to December 2017 were retrospectively reviewed. A total of 179 procedures were performed via TA (N=137) and TL (N=42) approaches, with 36 patients undergoing multiple embolizations. Clinical success was defined as absence of endoleak and/or aneurysm sac enlargement on follow-up imaging. Medical comorbidities, procedural data including fluoroscopy times, embolic agents used, location of endoleak, number of vessels embolized, presence of successful nidus embolization, and 30-day morbidity and mortality were collected. T-test and Chi square tests were used to assess statistical significance. Mean fluoroscopy time was 32.9±18.4 vs. 23.8±12.4min for TA and TL approaches respectively (p=0.004). Mean time from EVAR to first endoleak embolization was 576±463 days. Clinical success rates were 55% (N=76/137) and 67% (N=28/42) for TA and TL procedures respectively (p=0.20). For patients who underwent one embolization, clinical success rates were similar between the approaches (TA 79%, N=62/79; TL 80%, N=12/15; p=0.90). In cases requiring re-intervention, the TA approach had a lower clinical success rate of 42% (N=10/24) vs. 75% (N=18/24) for TL procedures (p=0.019). For TL approaches, clinical success rates were higher when both the nidus and branch vessels were embolized (N=13/17, 76%) compared to when only the nidus was embolized (N=11/25, 44%) (p=0.037). The 30-day complication rate for all patients was 1.5%(N=2/130), 2.3%(N=3/130), and 3.1%(N=4/130) for grade A, B, and C complications respectively, as per the SIR classification system. No periprocedural deaths were recorded. Clinical success in the endovascular management of type 2 endoleaks is multifactorial. Preliminary analysis in this retrospective review identified improved clinical success rates post reintervention using a TL approach, as well as superior efficacy of combined nidus and branch embolization.