Embolization of persistent type 2 endoleaks after endovascular treatment of abdominal aortic aneurysms: a study of long-term success

Abstract

Endovascular treatment of abdominal aortic aneurysms (EVAR) has been shown to be effective, with lower perioperative mortality and morbidity than open surgical treatment in patients with compatible anatomy. This benefit is lost after three years of follow-up. This could be explained by the higher rate of reintervention in EVAR patients due to endoleaks. Around half of patients with a persistent type 2 endoleak have an increase in aneurysm size. Either endovascular or by conventional surgery techniques have been described to treat this type of endoleak. The aim of this study was to measure the long-term success rate of embolization of type 2 endoleaks (T2EL) in a pragmatic retrospective series.A total of 592 patients underwent stent-graft surgery at CHU Amiens Picardie during the study period. During follow-up, endoleaks were observed in 140 patients (25 type 1, 122 T2EL, 8 type 3, 1 type 4 and 4 type 5 endoleaks). Concerning T2EL type, 53 were not persistent. Treatment decision was ordered for 30 patients. Among them, 22 patients underwent primary embolization (73%), 7 patients underwent primary surgical treatment (23%) and 1 patient underwent emergency endovascular extension for aortic rupture. The technical success were achieved in all procedures (n=22) , after embolization, the median follow up was 51 months [29.25 – 59.75]. At the end oft he study 8 patients (36%) were considered in „clinical success“ with no difference among embolization procedure, embolization agent used or initial clinical characteristics.We report that embolization procedures have a low clinical sucess rate durign follow-up. Further studies should investigate the etiologies of sac enlargement after embolization, that could be related with of a wrong categorization of initial endoleak.