Improved results using Onyx glue for the treatment of persistent type 2 endoleak after endovascular aneurysm repair

Abstract

Persistent type 2 (PT2) endoleaks (present ≥ 6 months) after endovascular aneurysm repair are associated with adverse outcomes, and selective secondary intervention is indicated in those patients with an expanding aneurysm sac. This study evaluated the outcomes of secondary intervention for PT2. From 1999 to 2007, 136 patients who underwent endovascular aneurysm repair developed PT2 and comprised the study cohort. Primary end points included PT2 resolution (secondary interventional success) and survival, and were evaluated using multiple logistic regression and Kaplan-Meier analyses, respectively. Fifty-one patients underwent a total of 68 secondary interventions for PT2 with expanding aneurysm sacs with a median postsecondary interventional follow-up of 13.7 months. Secondary interventions included 20 inferior mesenteric artery coil embolizations, 17 Onyx glue embolizations, 11 aneurysm sac coil embolizations, 10 non-Onyx glue embolizations, 7 lumbar artery coil embolizations, 2 open lumbar ligations, and 1 graft explant. The overall secondary interventional success rate was 43% (29 of 68). Onyx glue embolization was associated with a greater success rate when used as the initial secondary intervention (odds ratio, 59.61; 95% confidence interval, 4.78-742.73; P < .001). There was no difference in success between the different techniques when multiple secondary interventions were required. Five-year survival was 72% ± 0.08% and was unrelated to any of the secondary interventional techniques. Secondary intervention for PT2 is associated with success in less than half of all cases. Onyx glue embolization was associated with greater long-term success when used as the initial secondary intervention.