Can Type II Endoleak and Related Complications be Prevented? Monocentric Experience and Results

Introduction and aims: Up to 25% of EVAR present type II leak. We evaluated if it is possible: 1) to identify preoperative risk factors potentially predicting type II endoleak occurrence and 2) the role and effectiveness of intraprocedural sac embolization

Materials and methods: A retrospective analysis was conducted: from 2019 and 2021 we treated by EVAR 100 patients, 30% of them developed a ELII. We performed intra-EVAR AAA sac embolization in 12 patients. We matched the occurrence of ELII with anatomic and clinical variables: IMA patency, diameter, lumbars mean diameter, lumbars patency, AAA diameter, AAA anatomic complexity according to EUROSTAR classification, presence of aortic mural thrombus. We worked out the results in terms of AAA related death rate and effectiveness of aneurismal sac embolization. Patients were followed up during a mean period of 7 months. AAA related death and long-term survival rate were analyzed by Kaplan-Mayer analysis.

Results: IMA patency and diameter more than 2 mm significantly increased incidence of ELII, respectively 48%vs13% (p<.008) and 38%vs15% (p<.05). The same for lumbar arteries, 64%vs21% (p<.003) and 36%vs14% (p=ns). AAA diameter > 5cm and anatomical complexity are responsible of more ELII incidence, 32%vs26% (p=ns) and 53%vs22% (p<.002). Distribution of mural thrombus significantly decreased the endoleak, 37%vs15% (p<.05). Sac embolization showed less endoleak occurrence 40%vs60% (p=ns). One patient with ELII died 6months after EVAR because the rupture of the AAA. We obtained a mortality 3%vs0%.

Conclusion: ELII is a potential cause of AAAsac growth and rupture. Predictive factors analysis is mandatory. Intraoperative embolization, in case of feeding arteries more than 2mm diameter and postoperative embolization, if angio-CT shows a ELII with aneurismal sac increasing, are both advisable. In case of second endovascular sealing failure, open surgery should be considered.

Publication History

Article published online:
11 June 2024