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Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2022; 9(02): 129-143
DOI: 10.1055/a-1736-9091
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Typ-II-Endoleak nach EVAR: Diagnostik, Therapie und Prävention

Wiebke Kurre
,
Michael Kerezsy
,
Marcus Wagenschwanz
,
Till Proschek
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Endovaskulär versorgte Bauchaortenaneurysmen haben im Vergleich zu operierten eine geringere Langzeitstabilität. Ursächlich dafür kann eine bleibende oder neu entstehende periprothetische Perfusion (Endoleak) mit anhaltendem Druck im Aneurysma sein. Am häufigsten sind Typ-II-Endoleaks, die durch in den Aneurysmasack mündende Gefäße unterhalten werden. Dieser Beitrag beleuchtet die wichtigsten Aspekte in Diagnostik, Therapie und Prävention.

Abstract

EVAR is a safe and effective first line treatment for abdominal aortic aneurysms. However, long term stability remains inferior compared to open surgery mainly due to endoleaks promoting aneurysm perfusion and growth. Retrograde aneurysm sac inflow via aortic side branches is the most frequent cause and classified as type II endoleak. The majority of endoleaks II disappear spontaneously or show a benign course. On the other hand 30 % behave aggressively, ultimately leading to increasing aneurysm diameter and possibly rupture. This review summarizes recommendations regarding follow-up after EVAR and indication for treatment of type II endoleak. Advantages and disadvantages of different imaging modalities for surveillance (CT-angiography, duplex ultrasound / contrast enhanced ultrasound, MRI-angiography) are discussed. We provide an overview of treatment approaches (transarterial, translumbar, transcaval, surgery) and a broad spectrum of embolization materials. Finally, current knowledge on endoleak prevention by embolization of aortic side branches prior to EVAR ist summarized.

Kernaussagen

  • Endoleaks sind ein wesentlicher Faktor für die im Vergleich zur operativen Therapie ungünstigere Langzeitstabilität endovaskulär behandelter Aortenaneurysmen im Vergleich zur Operation. Eine konsequente Nachbeobachtung ist daher erforderlich.

  • Typ-II-Endoleaks sind am häufigsten und entstehen durch einen Einstrom über aortale Seitenäste. Sie können unmittelbar nach der Behandlung bereits vorhanden sein oder im Verlauf neu entstehen. Spontanverschlüsse sind insbesondere bei frühen Typ-II-Endoleaks möglich.

  • Typ-II-Endoleaks sind dann behandlungsbedürftig, wenn es zu einem signifikanten Wachstum des Aneurysmasacks kommt (Zunahme des Durchmessers um mindestens 5 mm).

  • Die Behandlung erfolgt primär durch eine minimalinvasive Embolisation mit Coils oder Flüssigembolisat. Mögliche Zugangswege zum Nidus sind die transarterielle Sondierung oder eine translumbale, seltener eine transkavale Punktion.

  • Häufig sind wiederholte Eingriffe erforderlich. Wenn die minimalinvasive Therapie nicht greift, kann eine operative Konversion notwendig werden.

  • Zur Prävention des Typ-II-Endoleaks können in den Aneurysmasack mündende Gefäße oder der Aneurysmasack selbst embolisiert werden.

Schlüsselwörter

Endoleak - Typ-II-Endoleak - EVAR - Embolisation - Prävention

Keywords

endoleak, type II endoleak, EVAR, embolization, prevention


Publication History

Article published online:
07 June 2022

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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