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Mid-term Outcomes and Predictors of Transarterial Embolization for Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the mid-term outcomes of transarterial embolization (TAE) for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR) and investigate the predictors of sac enlargement after embolization.

Materials and Methods

We conducted a retrospective analysis of 55 patients [48 men and 7 women, median age 79.0 (interquartile ranges 74–82) years] who underwent TAE for type II endoleak from 2010 to 2018. The aneurysmal sac enlargement, endoleaks, aneurysm-related adverse event rate, and reintervention rate were evaluated. Patients’ characteristics and clinical factors were evaluated for their association with sac enlargement.

Results

Fifty-five patients underwent TAE with technical success and were subsequently followed for a median of 636 (interquartile ranges 446–1292) days. The freedom from sac enlargement rates at 1, 3, and 5 years was 73.2%, 32.0%, and 26.7%, respectively. After initial TAE, the recurrent type II, delayed type I, and occult type III endoleak were identified in 39 (71%), 5 (9%), and 3 (5%) patients, respectively. Although a patient had aorto-duodenal fistula, there was no aneurysm-related death. The freedom from reintervention rates was 84.6%, 35.7%, and 17.0%, respectively. In the multivariate analysis, sac diameter > 55 mm at initial TAE (hazard ratios, 3.23; 95% confidence intervals, 1.22–8.58; P < 0.05) was a significant predictor of sac enlargement.

Conclusion

TAE for type II endoleak was not effective in preventing sac enlargement, and reinterventions were required among the mid-term follow-up. The sac diameter > 55 mm at initial TAE was a significant predictor of sac enlargement.

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Abbreviations

TAE:

Transarterial embolization

T2EL:

Type II endoleak

T1EL:

Type I endoleak

T3EL:

Type III endoleak

ARAE:

Aneurysm-related adverse event

IMA:

Inferior mesenteric artery

LA:

Lumbar artery

NBCA:

N-butyl-2-cyanoacrylate

References

  1. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. New Engl J Med. 2010;362(20):1863–71.

    Article  PubMed  CAS  Google Scholar 

  2. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302(14):1535–42.

    Article  CAS  PubMed  Google Scholar 

  3. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM. Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366–74.

    Article  PubMed  Google Scholar 

  4. Gelfand DV, White GH, Wilson SE. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg. 2006;20(1):69–74.

    Article  PubMed  Google Scholar 

  5. Choke E, Thompson M. Endoleak after endovascular aneurysm repair: current concepts. J Cardiovasc Surg. 2004;45(4):349–66.

    CAS  Google Scholar 

  6. Jones JE, Atkins MD, Brewster DC, Chung TK, Kwolek CJ, LaMuraglia GM, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007;46(1):1–8.

    Article  PubMed  Google Scholar 

  7. Walker J, Tucker LY, Goodney P, Candell L, Hua H, Okuhn S, 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(3):551–61.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hajibandeh S, Ahmad N, Antoniou GA, Torella F. Is intervention better than surveillance in patients with type 2 endoleak post-endovascular abdominal aortic aneurysm repair? Interact Cardiovasc Thorac Surg. 2015;20(1):128–34.

    Article  PubMed  Google Scholar 

  9. Wyss TR, Brown LC, Powell JT, Greenhalgh RM. Rate and predictability of graft rupture after endovascular and open abdominal aortic aneurysm repair: data from the EVAR Trials. Ann Surg. 2010;252(5):805–12.

    Article  PubMed  Google Scholar 

  10. El Batti S, Cochennec F, Roudot-Thoraval F, Becquemin JP. Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg. 2013;57(5):1291–7.

    Article  PubMed  Google Scholar 

  11. Madigan MC, Singh MJ, Chaer RA, Al-Khoury GE, Makaroun MS. Occult type I or III endoleaks are a common cause of failure of type II endoleak treatment after endovascular aortic repair. J Vasc Surg. 2019;69(2):432–9.

    Article  PubMed  Google Scholar 

  12. Ultee KHJ, Buttner S, Huurman R, Bastos Goncalves F, Hoeks SE, Bramer WM, 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(6):794–807.

    Article  PubMed  Google Scholar 

  13. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. 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(1):8–93.

    Article  PubMed  Google Scholar 

  14. 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):1600–3.

    Article  PubMed  Google Scholar 

  15. Sarac TP, Gibbons C, Vargas L, Liu J, Srivastava S, Bena J, et al. Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg. 2012;55(1):33–40.

    Article  PubMed  Google Scholar 

  16. Aziz A, Menias CO, Sanchez LA, Picus D, Saad N, Rubin BG, et al. Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion. J Vasc Surg. 2012;55(5):1263–7.

    Article  PubMed  Google Scholar 

  17. Torikai H, Inoue M, Nakatsuka S, Tamura M, Yashiro H, Yoshitake A, et al. Imaging findings of atypical type II endoleak through vasa vasorum after abdominal endovascular aneurysm repair. Cardiovasc Intervent Radiol. 2018;41(1):186–90.

    Article  PubMed  Google Scholar 

  18. Gentsu T, Okada T, Yamaguchi M, Horinouchi H, Katayama N, Ueshima E, et al. Type II endoleak after endovascular aortic aneurysm repair using the endurant stent graft system for abdominal aortic aneurysm with occluded inferior mesenteric artery. Cardiovasc Intervent Radiol. 2019;42(4):505–12.

    Article  PubMed  Google Scholar 

  19. Natrella M, Rapellino A, Navarretta F, Iob G, Cristoferi M, Castagnola M, et al. Embo-EVAR: a technique to prevent type II endoleak? A single-center experience. Ann Vasc Surg. 2017;44:119–27.

    Article  PubMed  Google Scholar 

  20. Bockler D, Holden A, Thompson M, Hayes P, Krievins D, de Vries JP, et al. Multicenter nellix endovascular aneurysm sealing system experience in aneurysm sac sealing. J Vasc Surg. 2015;62(2):290–8.

    Article  PubMed  Google Scholar 

  21. Ogawa Y, Nishimaki H, Osuga K, Ikeda O, Hongo N, Iwakoshi S, et al. A multi-institutional survey of interventional radiology for type II endoleaks after endovascular aortic repair: questionnaire results from the Japanese Society of endoluminal metallic stents and grafts in Japan. Jpn J Radiol. 2016;34(8):564–71.

    Article  CAS  PubMed  Google Scholar 

  22. JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011). Circ J. 2013;77:789–828.

    Article  CAS  Google Scholar 

  23. Hoshina K, Ishimaru S, Sasabichi Y, Yasunaga H, Komori K. Outcomes of endovascular repair for abdominal aortic aneurysms: a nationwide survey in Japan. Ann Surg. 2019;269(3):564–73.

    Article  PubMed  Google Scholar 

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan

    Hiroki Horinouchi, Takuya Okada, Masato Yamaguchi, Koji Sasaki, Tomoyuki Gentsu, Eisuke Ueshima, Keitaro Sofue, Koji Sugimoto & Takamichi Murakami

  2. Department of Radiology, Hyogo Brain and Heart Center at Himeji, Himeji, Japan

    Koji Maruyama & Ryota Kawasaki

  3. Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan

    Yoshikatsu Nomura

  4. Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Atsushi Omura & Kenji Okada

Authors
  1. Hiroki Horinouchi
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  2. Takuya Okada
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  3. Masato Yamaguchi
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  4. Koji Maruyama
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  9. Ryota Kawasaki
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  10. Yoshikatsu Nomura
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  11. Atsushi Omura
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  12. Kenji Okada
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  13. Koji Sugimoto
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  14. Takamichi Murakami
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Correspondence to Takuya Okada.

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Consent for publication was obtained for the data of every individual person’s data included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. The institutional review board approved this retrospective study.

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Horinouchi, H., Okada, T., Yamaguchi, M. et al. Mid-term Outcomes and Predictors of Transarterial Embolization for Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 43, 696–705 (2020). https://doi.org/10.1007/s00270-020-02436-2

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  • DOI: https://doi.org/10.1007/s00270-020-02436-2

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