Abstract
The aims of the present study were to examine the impact of type 2 endoleaks (T2EL) on overall survival and to determine the need for secondary intervention after endovascular aneurysm repair (EVAR). A multicentre retrospective cohort study in the Netherlands was conducted among patients with an infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between 2007 and 2012. The primary endpoint was overall survival for patients with (T2EL+) or without (T2EL-) a T2EL. Secondary endpoints were sac growth, AAA rupture, and secondary intervention. Kaplan-Meier survival and multivariable Cox regression analysis were used. A total of 2 018 patients were included. The median follow up was 62.1 (range 0.1 - 146.2) months. No difference in overall survival was found between T2EL+ (n= 388) and T2EL- patients (n= 1630) (p= .54). The overall survival estimates at five and 10 years were 73.3%/69.4% and 45.9%/44.1% for T2EL+/T2EL- patients, respectively. Eighty-five of 388 (21.9%) T2EL+ patients underwent a secondary intervention. There was no difference in overall survival between T2EL+ patients who underwent a secondary intervention and those who were treated conservatively (p= .081). Sac growth was observed in 89 T2EL+ patients and 44/89 patients (49.4%) underwent a secondary intervention. In 41/44 cases (93.1%), sac growth was still observed after the intervention, but was left untreated. Aneurysm rupture occurred in 4/388 T2EL patients. In Cox regression analysis, higher age, ASA classification, and maximum iliac diameter were significantly associated with worse overall survival. No difference in overall survival was found between T2EL+ and T2EL- patients. Also, patients who underwent a secondary intervention did not have better survival compared with those who did not undergo a secondary intervention. This study reinforces the need for conservative treatment of an isolated T2EL and the importance of a prospective study to determine possible advantages of the intervention.
Highlights
Endovascular aneurysm repair (EVAR) is a procedure used to repair an abdominal aortic aneurysm (AAA) in patients y The members of the ODYSSEUS study group and collaborators are listed at the Acknowledgments section that a type 2 endoleaks (T2EL) is a benign complication,[8,12] whereas others have associated Type 2 endoleaks (T2ELs) with adverse late outcomes resulting in a high secondary intervention rate and significant risk of aneurysm related complications.[13]
No endoleak was identified in 1 630 patients (80.8%), and an isolated T2EL was found in 388 patients (19.2%)
Important findings regarding T2EL after EVAR were examined in further detail: 1) the incidence of an isolated T2EL in the present study was 17%, 2) no difference in overall survival was identified between patients with or without a T2EL, and no difference in overall survival was observed between patients with a T2EL who underwent a secondary intervention and those who did not undergo secondary intervention, 3) survival in patients with an early onset T2EL was worse than that of patients with a late onset T2EL
Summary
Endovascular aneurysm repair (EVAR) is a procedure used to repair an abdominal aortic aneurysm (AAA) in patients y The members of the ODYSSEUS study group and collaborators are listed at the Acknowledgments section that a T2EL is a benign complication,[8,12] whereas others have associated T2EL with adverse late outcomes resulting in a high secondary intervention rate and significant risk of aneurysm related complications.[13] If there is a T2EL with aneurysm sac expansion, the 2019 European Society for Vascular Surgery (ESVS) guideline recommends imaging to rule out a type 1 or a type 3 endoleak.[14] Current guidelines recommend conservative treatment for T2EL; if the aneurysm sac increases by more than 10 mm, secondary intervention is recommended.[14]. Analysing the long term effects of T2ELs using a large dataset may lead to greater consensus about treatment protocols and may give direction to management of T2ELs
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