Abstract
ObjectivesThis systematic review and meta-analysis aims to determine the current evidence on risk factors for type II endoleaks after endovascular aneurysm repair (EVAR).Materials and methodsA systematic literature search was carried out for studies that evaluated the association of demographic, co-morbidity, and other patient-determined factors with the onset of type II endoleaks. Pooled prevalence of type II endoleaks after EVAR was updated.ResultsAmong the 504 studies screened, 45 studies with a total of 36,588 participants were included in this review. The pooled prevalence of type II endoleaks after EVAR was 22% [95% confidence interval (CI), 19%–25%]. The main factors consistently associated with type II endoleaks included age [pooled odds ratio (OR), 0.37; 95% CI, 0.31–0.43; P<0.001], smoking (pooled OR, 0.71; 95% CI, 0.55–0.92; P<0.001), patent inferior mesenteric artery (pooled OR, 1.98; 95% CI, 1.06–3.71; P = 0.012), maximum aneurysm diameter (pooled OR, 0.23; 95% CI, 0.17–0.30; P<0.001), and number of patent lumbar arteries (pooled OR, 3.07; 95% CI, 2.81–3.33; P<0.001). Sex, diabetes, hypertension, anticoagulants, antiplatelet, hyperlipidemia, chronic renal insufficiency, types of graft material, and chronic obstructive pulmonary diseases (COPD) did not show any association with the onset of type II endoleaks.ConclusionsClinicians can use the identified risk factors to detect and manage patients at risk of developing type II endoleaks after EVAR. However, further studies are needed to analyze a number of potential risk factors.
Highlights
Endovascular aneurysm repair (EVAR) has become the primary choice of treatment for abdominal aortic aneurysms (AAAs) in suitable patients [1]
The main factors consistently associated with type II endoleaks included age [pooled odds ratio (OR), 0.37; 95% confidence interval (CI), 0.31–0.43; P
Further studies are needed to analyze a number of potential risk factors
Summary
Endovascular aneurysm repair (EVAR) has become the primary choice of treatment for abdominal aortic aneurysms (AAAs) in suitable patients [1]. EVAR always has better shortterm outcomes compared with open repair [2,3]. Migration, and endoleaks are known complications after EVAR [4], among which endoleaks are the most frequent. Types I and III endoleaks require urgent intervention to relieve aneurysm re-pressurization [5,6]. Type II endoleaks are caused by backflow of collateral arteries into the aneurysm sac, with an occurrence rate of 10.2% after EVAR [7]. Type II endoleaks do not exert any immediate adverse effects. Persistent type II endoleaks are believed to be associated with increased sac pressure and cause adverse outcomes and even aneurysm rupture [8]
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