Outcomes of patients with type I endoleak at completion of endovascular abdominal aneurysm repair

Abstract

Type I endoleak (TIE) during endovascular aneurysm repair (EVAR) is usually identified and treated intraoperatively. We evaluated the outcomes of patients who, despite possible treatment, had TIE at completion of EVAR. We examined consecutive EVAR for nonruptured abdominal aortic aneurysm (AAA) within the Vascular Study Group of New England database (2003-2012) and compared the outcomes of patients who had TIE at completion with those who did not. Outcomes included perioperative death, cardiac complication, reoperation, and 1-year mortality. Multivariable logistic regression was used to determine factors associated with perioperative mortality, as well as factors associated with TIE. Anatomic factors associated with TIE were not evaluated because of the limitations of the Vascular Study Group of New England database. Among the 2402 EVARs for nonruptured AAA in the Vascular Study Group of New England sample, 93% (n=2235) were performed electively and 7% had (n = 167) symptomatic AAA. Eighty patients (3.3%) had TIE at completion of surgery. Patients with TIE were older (77.9 vs 73.9years; P< .001), had higher female preponderance (34% vs 20%; P= .004), larger endograft main body diameter (28.8 vs 27.2mm; P< .001), and more unplanned graft extension (32% vs 10%; P< .001) than those without TIE. At 1-year follow-up, 90% of patients who had TIE at the completion of their EVAR had resolution of TIE without further need for endovascular intervention or open conversion type I endoleak at the completion of surgery was associated with increased in-hospital mortality (5% vs 0.6%; P= .002) and cardiac dysrhythmia (8.8% vs 3.2%; P= .02). In multivariable analysis, TIE was independently associated with increased odds of in-hospital mortality (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.2-16.4; P= .03). Multivariable analysis revealed the following factors to be independently predictive of TIE: female gender (OR, 2.2, 95% CI, 1.3-3.7; P= .002), patients older than 70years of age (OR, 2.0; 95% CI, 1.1-3.8; P= .02), those with main body graft diameter >30mm (OR, 2.6; 95%CI, 1.6-4.3; P< .001), and those undergoing unplanned graft extension (OR, 4.6; 95% CI, 2.7-7.7; P<.001). TIE occurred in 3% of patients at completion of EVAR with more than 90% resolved spontaneously at 1-year follow-up. It is associated with increased risk of in-hospital mortality and cardiac complication. Additional investigation is needed to further define anatomic factors associated with TIE and to improve perioperative outcomes of these at-risk patients.