The Influence of 4 or more Patent Lumbar Arteries on Persistent Type II Endoleak and Sac Expansion after Endovascular Aneurysm Repair

Abstract

This study aimed to review our clinical results and determine how preoperative patent lumbar arteries (LAs) influence the occurrence of type II endoleaks or aneurysm sac enlargement after endovascular aneurysm repair (EVAR) and to identify the preoperative computed tomography findings of persistent type II endoleaks from patent LAs that indicate the need for preventive procedures during EVAR. A total of 293 patients who underwent EVAR for infrarenal abdominal aortic aneurysm (AAA) between August 2007 and July 2013 were reviewed. Follow-up data were available for 194 patients (76% male, mean age 78±6.8years), and the mean follow-up time was 57±23months. The number of patent LAs was identified as a significant positive predictor of persistent type II endoleaks (hazard ratio [HR], 1.4; 95% confidence interval [CI]: 1.2-1.7; P<0.001) and sac enlargement (≥5mm) at the 2-year follow-up period (HR, 1.3; 95% CI: 1.1-1.8; P=0.009) after EVAR, using Cox regression analysis. The receiver operating characteristics curve (AUC: 0.72) showed that a cutoff of 4 patent LAs resulted in a sensitivity of 87% and specificity of 48%. The rates of freedom from sac enlargement (≥5mm) at 3 and 5years after EVAR were significantly lower in patients with 4 or more patent LAs than in those with fewer (90% and 76% vs. 96% and 89%; P=0.0008). The number of patent LAs is associated as a significant risk factor with the development of persistent type II endoleaks and sac enlargement after EVAR. Four or more patent LAs should be recognized as the group having an elevated risk of developing late sac enlargement after EVAR.