When Endovascular Interventions for Endoleaks Fail

Abstract

In the appropriate patient population, endovascular aortic repair (EVAR) has become the standard of care for abdominal aortic aneurysms. While the initial success rates of EVAR are very high, reinterventions occur in a significant minority of patients, most of which consist of the repair of endoleaks. When indicated, such procedures are typically performed via endovascular or percutaneous approaches; however, in certain patients, these minimally invasive repairs fail. In these patients, surgical techniques can be used to treat the endoleaks. This article describes the open surgical techniques used in the repair of endoleaks where standard endovascular techniques fail.

Keywords

endograft - endoleak - open repair - interventional radiology - vascular surgery

Publikationsverlauf

Artikel online veröffentlicht:
06. Januar 2025

• References

• 1 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5 (06) 491-499
• 2 Sapirstein W, Chandeysson P, Wentz C. The Food and Drug Administration approval of endovascular grafts for abdominal aortic aneurysm: an 18-month retrospective. J Vasc Surg 2001; 34 (01) 180-183
• 3 Sethi RKV, Henry AJ, Hevelone ND, Lipsitz SR, Belkin M, Nguyen LL. Impact of hospital market competition on endovascular aneurysm repair adoption and outcomes. J Vasc Surg 2013; 58 (03) 596-606
• 4 Dansey KD, Varkevisser RRB, Swerdlow NJ. et al. Epidemiology of endovascular and open repair for abdominal aortic aneurysms in the United States from 2004 to 2015 and implications for screening. J Vasc Surg 2021; 74 (02) 414-424
• 5 Gilmore BF, Scali ST, D'Oria M. et al. Temporal trends and outcomes of abdominal aortic aneurysm care in the United States. Circ Cardiovasc Qual Outcomes 2024; 17 (06) e010374
• 6 Dillavou ED, Muluk SC, Makaroun MS. Improving aneurysm-related outcomes: nationwide benefits of endovascular repair. J Vasc Surg 2006; 43 (03) 446-451 , discussion 451–452
• 7 Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004; 364 (9437): 843-848
• 8 Prinssen M, Verhoeven ELG, Buth J. et al; Dutch Randomized Endovascular Aneurysm Management (DREAM)Trial Group. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351 (16) 1607-1618
• 9 Lederle FA, Freischlag JA, Kyriakides TC. et al; Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009; 302 (14) 1535-1542
• 10 Wanken ZJ, Barnes JA, Trooboff SW. et al. A systematic review and meta-analysis of long-term reintervention after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2020; 72 (03) 1122-1131
• 11 Mehta M, Sternbach Y, Taggert JB. et al. Long-term outcomes of secondary procedures after endovascular aneurysm repair. J Vasc Surg 2010; 52 (06) 1442-1449
• 12 Zaiem F, Almasri J, Tello M, Prokop LJ, Chaikof EL, Murad MH. A systematic review of surveillance after endovascular aortic repair. J Vasc Surg 2018; 67 (01) 320-331.e37
• 13 Chaer RA, Avgerinos E. Endoleak following endovascular aortic repair. In: Connor RF. ed. 2024. Wolters Kluwer;
• 14 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
• 15 Chaikof EL, Blankensteijn JD, Harris PL. et al; Ad Hoc Committee for Standardized Reporting Practices in Vascular Surgery of The Society for Vascular Surgery/American Association for Vascular Surgery. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 2002; 35 (05) 1048-1060
• 16 Moll FL, Powell JT, Fraedrich G. et al; European Society for Vascular Surgery. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 2011; 41 (Suppl. 01) S1-S58
• 17 Schermerhorn ML, Buck DB, O'Malley AJ. et al. Long-term outcomes of abdominal aortic aneurysm in the Medicare population. N Engl J Med 2015; 373 (04) 328-338
• 18 Chaer RA, Gushchin A, Rhee R. et al. Duplex ultrasound as the sole long-term surveillance method post-endovascular aneurysm repair: a safe alternative for stable aneurysms. J Vasc Surg 2009; 49 (04) 845-849 , discussion 849–850
• 19 Ameli-Renani S, Pavlidis V, Morgan RA. Secondary endoleak management following TEVAR and EVAR. Cardiovasc Intervent Radiol 2020; 43 (12) 1839-1854
• 20 Benjamin Colvard MD, Jason T. Lee, MD. Early Detection of Type I Endoleaks. Endovascular Today. Accessed August 14, 2024 at: https://evtoday.com/articles/2013-feb/early-detection-of-type-i-endoleaks
• 21 Candell L, Tucker LY, Goodney P. et al. Early and delayed rupture after endovascular abdominal aortic aneurysm repair in a 10-year multicenter registry. J Vasc Surg 2014; 60 (05) 1146-1153
• 22 McFarland G, Tran K, Virgin-Downey W. et al. Infrarenal endovascular aneurysm repair with large device (34- to 36-mm) diameters is associated with higher risk of proximal fixation failure. J Vasc Surg 2019; 69 (02) 385-393
• 23 Faries PL, Cadot H, Agarwal G, Kent KC, Hollier LH, Marin ML. Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. J Vasc Surg 2003; 37 (06) 1155-1161
• 24 Quintas A, Alves G. Three-vessel chimney technique combined with endovascular aortic sealing device for the treatment of a type Ia endoleak. Eur J Vasc Endovasc Surg 2017; 53 (03) 379
• 25 Qamhawi Z, Barge TF, Makris GC. et al. Editor's choice - systematic review of the use of endoanchors in endovascular aortic aneurysm repair. Eur J Vasc Endovasc Surg 2020; 59 (05) 748-756
• 26 Choi SY, Lee DY, Lee KH. et al. Treatment of type I endoleaks after endovascular aneurysm repair of infrarenal abdominal aortic aneurysm: usefulness of N-butyl cyanoacrylate embolization in cases of failed secondary endovascular intervention. J Vasc Interv Radiol 2011; 22 (02) 155-162
• 27 Mesnard T, Patterson BO, Azzaoui R, Pruvot L, Haulon S, Sobocinski J. Iliac branch device to treat type Ib endoleak with a brachial access or an “up-and-over” transfemoral technique. J Vasc Surg 2022; 76 (06) 1537-1547.e2
• 28 Kray J, Kirk S, Franko J, Chew DK. Role of type II endoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2015; 61 (04) 869-874
• 29 Seike Y, Matsuda H, Shimizu H. et al; Japanese Committee for Stentgraft Management (JACSM)*. Nationwide analysis of persistent type II endoleak and late outcomes of endovascular abdominal aortic aneurysm repair in Japan: a propensity-matched analysis. Circulation 2022; 145 (14) 1056-1066
• 30 Lalys F, Durrmann V, Duménil A. et al. Systematic review and meta-analysis of preoperative risk factors of type II endoleaks after endovascular aneurysm repair. Ann Vasc Surg 2017; 41: 284-293
• 31 Avgerinos ED, Chaer RA, Makaroun MS. Type II endoleaks. J Vasc Surg 2014; 60 (05) 1386-1391
• 32 van Marrewijk CJ, Fransen G, Laheij RJF, Harris PL, Buth J. EUROSTAR Collaborators. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg 2004; 27 (02) 128-137
• 33 Walker J, Tucker LY, Goodney P. et al. Type II endoleak with or without intervention after endovascular aortic aneurysm repair does not change aneurysm-related outcomes despite sac growth. J Vasc Surg 2015; 62 (03) 551-561
• 34 Uthoff H, Katzen BT, Gandhi R, Peña CS, Benenati JF, Geisbüsch P. Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg 2012; 56 (04) 965-972
• 35 Stoecker JB, Glaser JD. Review of type III endoleaks. Semin Intervent Radiol 2020; 37 (04) 371-376
• 36 Blakeslee-Carter J, Beck AW, Spangler EL. Type III endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative. J Vasc Surg 2022; 75 (04) 1172-1180
• 37 Cifuentes S, Mendes BC, Tabiei A, Scali ST, Oderich GS, DeMartino RR. Management of endoleaks after elective infrarenal aortic endovascular aneurysm repair: a review. JAMA Surg 2023; 158 (09) 965-973
• 38 White SB, Stavropoulos SW. Management of endoleaks following endovascular aneurysm repair. Semin Intervent Radiol 2009; 26 (01) 33-38
• 39 Chen J, Stavropoulos SW. Management of endoleaks. Semin Intervent Radiol 2015; 32 (03) 259-264
• 40 Toya N, Fujita T, Kanaoka Y, Ohki T. Endotension following endovascular aneurysm repair. Vasc Med 2008; 13 (04) 305-311
• 41 Wever JJ, Blankensteijn JD, Th M Mali WP, Eikelboom BC, Eikelboom BC. Maximal aneurysm diameter follow-up is inadequate after endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2000; 20 (02) 177-182
• 42 Rajendran S, May J. Late rupture of abdominal aortic aneurysm after endovascular repair. J Vasc Surg 2017; 65 (01) 52-57
• 43 Arnaoutakis DJ, Sharma G, Blackwood S. et al. Strategies and outcomes for aortic endograft explantation. J Vasc Surg 2019; 69 (01) 80-85
• 44 Scali ST, Beck AW, Chang CK. et al. Defining risk and identifying predictors of mortality for open conversion after endovascular aortic aneurysm repair. J Vasc Surg 2016; 63 (04) 873-81.e1
• 45 Suckow BD, Scali ST, Goodney PP. et al. Contemporary incidence, outcomes, and survival associated with endovascular aortic aneurysm repair conversion to open repair among Medicare beneficiaries. J Vasc Surg 2022; 76 (03) 671-679.e2
• 46 Cicala N, Perini P, Catasta A, Fornasari A, Ucci A, Freyrie A. Systematic review and meta-analysis of incidence, indications, and outcomes of early open conversions after EVAR for abdominal aortic aneurysms. Int Angiol 2024; 43 (02) 271-279
• 47 Moulakakis KG, Dalainas I, Mylonas S, Giannakopoulos TG, Avgerinos ED, Liapis CD. Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction. J Endovasc Ther 2010; 17 (06) 694-702
• 48 Kelso RL, Lyden SP, Butler B, Greenberg RK, Eagleton MJ, Clair DG. Late conversion of aortic stent grafts. J Vasc Surg 2009; 49 (03) 589-595
• 49 Cambria RP, Brewster DC, Abbott WM. et al. Transperitoneal versus retroperitoneal approach for aortic reconstruction: a randomized prospective study. J Vasc Surg 1990; 11 (02) 314-324 , discussion 324–325
• 50 Sicard GA, Reilly JM, Rubin BG. et al. Transabdominal versus retroperitoneal incision for abdominal aortic surgery: report of a prospective randomized trial. J Vasc Surg 1995; 21 (02) 174-181 , discussion 181–183
• 51 Jimenez JC, Moore WS, Quinones-Baldrich WJ. Acute and chronic open conversion after endovascular aortic aneurysm repair: a 14-year review. J Vasc Surg 2007; 46 (04) 642-647
• 52 Lipsitz EC, Ohki T, Veith FJ. et al. Delayed open conversion following endovascular aortoiliac aneurysm repair: partial (or complete) endograft preservation as a useful adjunct. J Vasc Surg 2003; 38 (06) 1191-1198
• 53 Salem KM, Singh MJ. EVAR: open surgical repair options for persistent type Ia endoleaks. Semin Intervent Radiol 2020; 37 (04) 377-381