IP069. Select Type I and Type III Endoleaks at the Completion of Fenestrated Endovascular Aneurysm Repair Are Safe to Observe

Abstract

The Society for Vascular Surgery/American Association for Vascular Surgery reporting standards for endovascular aneurysm repair (EVAR) consider the presence of a type I or type III endoleak a technical failure. However, the nature of these endoleaks in fenestrated EVAR (FEVAR) is not well understood. We performed a retrospective review of all patients who underwent FEVAR at our institution with the Zenith Fenestrated AAA Endovascular Graft (Cook Medical, Bloomington, Ind) from 2013 to 2018. Small, slow type I and type III endoleaks at the end of the index procedure were routinely observed. We identified patients with type I or type III endoleaks by review of the completion angiogram and subsequently characterized endoleak type and location. Of 49 patients who underwent FEVAR, 28 (57%) had evidence of a type I or type III endoleak after implantation of all devices. Eleven patients underwent further intervention at the index procedure, and three endoleaks resolved completely. Twenty-five patients (51%) had a type I or type III endoleak on completion angiography. We excluded three patients without postoperative imaging: two yet to complete initial postoperative computed tomography angiography or duplex ultrasound and one lost to follow-up after discharge. For the 22 remaining patients, mean age was 75.6 years; 77% were male, and 77% were white. Mean aneurysm diameter was 61 mm. There were 61 branch vessels (42 renal arteries and 19 superior mesenteric arteries) targeted with 44 fenestrations and 17 scallops; 44 target vessels were stented with 41 covered stents and 3 bare-metal stents. Median follow-up was 255 days (range, 34-1352 days). Of the 22 completion endoleaks, 12 were type III, one was type IA, and 9 were indeterminate (either type IA or type III; Table). No type I or type III endoleaks were identified on initial postoperative computed tomography angiography. Furthermore, no type I or type III endoleaks were identified on any follow-up imaging. Of 12 patients with at least 6-month follow-up, 6 had sac regression, 5 had stable sac diameter, and 1 had sac expansion. The patient with sac expansion underwent reintervention for persistent type II endoleak. There were no aneurysm ruptures or deaths. In patients undergoing FEVAR with the Zenith Fenestrated AAA Endovascular Graft, small, slow type I and type III endoleaks resolve spontaneously and can be safely observed. Continued research is necessary to evaluate long-term outcomes in these patients.TableLocation of type I and type III endoleaks present on completion angiographyEndoleak locationNo. (%)Type IA or junction of main body and renal stent grafta8 (36)Type IA or junction of main body and renal stent graft and junction of main body and bifurcatea1 (5)Junction of main body and renal stent graft1 (5)Junction of main body and bifurcate4 (18)Junction of main body and bifurcate or bifurcate and iliac limba5 (23)Junction of bifurcate and iliac limb2 (9)Type I (from large unstented right renal artery fenestration)1 (5)aExact location of endoleak origin could not be determined. Open table in a new tab