Type 2 Endoleak Management

Abstract

Type 2 endoleaks are the most common endoleak type following endovascular aneurysm repair. The natural history of these endoleaks can vary, with some demonstrating a self-limited or indolent course, while others can contribute to aneurysm sac enlargement and rupture. A variety of embolization techniques, including transarterial catheterization and direct sac puncture techniques, have been developed for the treatment of type 2 endoleaks. In this article, the authors review the indications, techniques, and outcomes of current treatment strategies for type 2 endoleaks.

Keywords

interventional radiology - endoleak - aortic aneurysm - embolization - stent graft

Publication History

Article published online:
01 October 2020

• References

• 1 Wanhainen A, Verzini F, Van Herzeele I. , et al; ESVS Guidelines Committee. Editor's choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg 2019; 57 (01) 8-93
• 2 Guo Q, Du X, Zhao J. et al. Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: A meta-analysis. PLoS One 2017; 12 (02) e0170600
• 3 Jones JE, Atkins MD, Brewster DC. et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg 2007; 46 (01) 1-8
• 4 Sidloff DA, Stather PW, Choke E, Bown MJ, Sayers RD. Type II endoleak after endovascular aneurysm repair. Br J Surg 2013; 100 (10) 1262-1270
• 5 Gelfand DV, White GH, Wilson SE. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg 2006; 20 (01) 69-74
• 6 van Marrewijk C, Buth J, Harris PL, Norgren L, Nevelsteen A, Wyatt MG. Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience. J Vasc Surg 2002; 35 (03) 461-473
• 7 Ultee KHJ, Büttner S, Huurman R. et al. Editor's choice - systematic review and meta-analysis of the outcome of treatment for Type II endoleak following endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2018; 56 (06) 794-807
• 8 Pineda DM, Calligaro KD, Tyagi S, Troutman DA, Dougherty MJ. Late type II endoleaks after endovascular aneurysm repair require intervention more frequently than early type II endoleaks. J Vasc Surg 2018; 67 (02) 449-452
• 9 Müller-Wille R, Borgmann T, Wohlgemuth WA. et al. Dual-energy computed tomography after endovascular aortic aneurysm repair: the role of hard plaque imaging for endoleak detection. Eur Radiol 2014; 24 (10) 2449-2457
• 10 McDonald MD, Paik HH, Fairman R. et al. Outcomes of type 2 endoleaks detected on venous phase CT arteriography. Diagn Interv Imaging 2018; 99 (04) 225-229
• 11 Inoue K, Furuyama T, Kurose S. et al. Platelets reflect the fate of type II endoleak after endovascular aneurysm repair. J Vasc Surg 2020; 72 (02) 541-548.e1
• 12 Chaikof EL, Dalman RL, Eskandari MK. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67 (01) 2-77.e2
• 13 Keedy AW, Yeh BM, Kohr JR, Hiramoto JS, Schneider DB, Breiman RS. Evaluation of potential outcome predictors in type II Endoleak: a retrospective study with CT angiography feature analysis. AJR Am J Roentgenol 2011; 197 (01) 234-240
• 14 Parent FN, Meier GH, Godziachvili V. et al. The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg 2002; 35 (03) 474-481
• 15 Bargellini I, Napoli V, Petruzzi P. et al. Type II lumbar endoleaks: hemodynamic differentiation by contrast-enhanced ultrasound scanning and influence on aneurysm enlargement after endovascular aneurysm repair. J Vasc Surg 2005; 41 (01) 10-18
• 16 Arko FR, Filis KA, Siedel SA. et al. Intrasac flow velocities predict sealing of type II endoleaks after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2003; 37 (01) 8-15
• 17 Stavropoulos SW, Park J, Fairman R, Carpenter J. Type 2 endoleak embolization comparison: translumbar embolization versus modified transarterial embolization. J Vasc Interv Radiol 2009; 20 (10) 1299-1302
• 18 Zener R, Oreopoulos G, Beecroft R, Rajan DK, Jaskolka J, Tan KT. Transabdominal direct sac puncture embolization of Type II endoleaks after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol 2018; 29 (08) 1167-1173
• 19 Burley CG, Kumar MH, Bhatti WA, Boyd C, Sales CM. Transcaval embolization as the preferred approach. J Vasc Surg 2019; 69 (04) 1309-1313
• 20 Mewissen MW, Jan MF, Kuten D, Krajcer Z. Laser-assisted transgraft embolization: a technique for the treatment of Type II endoleaks. J Vasc Interv Radiol 2017; 28 (11) 1600-1603
• 21 Chivot C, Bouzerar R, Yzet T, Reix T. Transarterial perigraft balloon-assisted Onyx embolization of Type II endoleak. J Vasc Interv Radiol 2019; 30 (04) 617-619
• 22 Khaja MS, Park AW, Swee W. et al. Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Intervent Radiol 2014; 37 (03) 613-622
• 23 Guo Q, Zhao J, Ma Y. et al. A meta-analysis of translumbar embolization versus transarterial embolization for type II endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2020; 71 (03) 1029-1034.e1
• 24 van Bindsbergen L, Braak SJ, van Strijen MJ, de Vries JP. Type II endoleak embolization after endovascular abdominal aortic aneurysm repair with use of real-time three-dimensional fluoroscopic needle guidance. J Vasc Interv Radiol 2010; 21 (09) 1443-1447
• 25 Rhee R, Oderich G, Hertault A. et al. Multicenter experience in translumbar type II endoleak treatment in the hybrid room with needle trajectory planning and fusion guidance. J Vasc Surg 2019; Doi: S0741-5214(19)32626-6 (epub ahead of print)
• 26 Stavropoulos SW, Carpenter JP, Fairman RM, Golden MA, Baum RA. Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol 2003; 14 (09) , Pt 1 1191-1194
• 27 Yu H, Desai H, Isaacson AJ, Dixon RG, Farber MA, Burke CT. Comparison of Type II endoleak embolizations: embolization of endoleak nidus only versus embolization of endoleak nidus and branch vessels. J Vasc Interv Radiol 2017; 28 (02) 176-184
• 28 Hyatt E, McLaughlin JN, Shah H, Kalva SP. Transcaval approach for embolization of type II Endoleak following endovascular aortic aneurysm repair. CVIR Endovasc. 2019; 2 (01) 3
• 29 Lagios K, Karaolanis G, Bazinas T, Perdikides T, Bountouris I. Translumbar infusion of N-butyl cyanoacrylate for the treatment of Type II endoleaks. J Vasc Interv Radiol 2018; 29 (06) 826-832
• 30 Nakai M, Ikoma A, Loffroy R. et al. Transgraft sac embolization combined with graft reinforcement for refractory mixed-type endoleak. Cardiovasc Intervent Radiol 2019; 42 (04) 620-624
• 31 Porta M, Cova M, Segreti S. et al. Laparoscopic clipping of the inferior mesenteric artery and intraoperative indocyanine green angiography for Type II endoleak following endovascular aneurysm repair. J Laparoendosc Adv Surg Tech A 2020; 30 (04) 413-415
• 32 Zhou W, Lumsden AB, Li J. IMA clipping for a Type II endoleak: combined laparoscopic and endovascular approach. Surg Laparosc Endosc Percutan Tech 2006; 16 (04) 272-275
• 33 Ling AJ, Pathak R, Garbowski M, Nadkarni S. Treatment of a large type II endoleak via extraperitoneal dissection and embolization of a collateral vessel using ethylene vinyl alcohol copolymer (Onyx). J Vasc Interv Radiol 2007; 18 (05) 659-662