Abstract
Background: Type II endoleak (T2EL) after endovascular aortic repair is associated with AAA sac enlargements in up to 25%, reduction of attachment zones and rarely with aortic rupture. Indications for therapy and efficacy of interventions of T2EL are not clearly established. Transarterial embolization with application of ethylene-vinyl alcohol copolymer has been described with varying outcomes. Aim of this study is to evaluate durability of OnyxTM embolization (OE) in T2EL in a consecutive series at a single tertiary vascular center. Patients and methods: Demographic data, technical success, pre- and postoperative aneurysm growth, morbidity, mortality and reintervention rates during hospital stay as well as in follow up were recorded in patients treated with OE for T2EL between 01/2015 and 12/2017. The primary endpoint was defined as persistence or reoccurrence of T2EL (durability of OE). Results: In total 15 patients (78±6years, 13 men) were treated with OE because of sac enlargement (average growth of 12±8%, n=12), persistent bleeding after AAA rupture (n=2) or persistent T2EL with stable but large aneurysm diameter (n=1). Mean length of stay was 8±11 days. Technical success was 93.3% (n=14). Inhospital-morbidity was 26.7%, in-hospital- and 1-year-mortality rate were 6.6% (n=1) and 20.0% (n=3). T2EL persisted in 20.0% (n=3) despite of OE. Re-EL-II occurred after 40 (30-114) days in 33.3% (n=5). Reintervention rate was 13.3% (n=2, atday 48 and 319). Altogether clinical success with stable aneurysm diameter was achieved in 80.0% (n=12), but durable elimination of EL was only achieved in 46.7% of patients (n=7). Conclusions: OE is technically possible in more than 90% of patients but might be associated with severe complications. Durability of this treatment is low, since T2EL persist or reoccur in more than 50% of all patients. OE of T2EL should be reserved for few selected cases.
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