Type II Endoleak After Endovascular Aortic Aneurysm Repair Using the Endurant Stent Graft System for Abdominal Aortic Aneurysm with Occluded Inferior Mesenteric Artery

  • Tomoyuki Gentsu
  • Takuya Okada
  • Masato Yamaguchi
  • Hiroki Horinouchi
  • Naoto Katayama
  • Eisuke Ueshima
  • Yutaka Koide
  • Keitaro Sofue
  • Yasuko Gotake
  • Yoshikatsu Nomura
  • Hiroshi Tanaka
  • Yutaka Okita
  • Koji Sugimoto
  • Takamichi Murakami
Clinical Investigation Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions



To evaluate the incidence of type II endoleak (EL-II) and aneurysm enlargement after endovascular aneurysm repair (EVAR) using the Endurant stent graft in patients with abdominal aortic aneurysm (AAA) with occluded inferior mesenteric artery (IMA).

Materials and Methods

Between 2012 and 2017, 103 patients who underwent EVAR using the Endurant stent graft for AAA with occluded IMA (50 patients with prophylactic embolized IMA and 53 with spontaneous occluded IMA) were retrospectively reviewed. The incidence of EL-II and aneurysm enlargement was evaluated. Predictive factors for persistent EL-II were evaluated based on patient characteristics, preprocedural anatomical characteristics, intraprocedural details, and postprocedural complications.


Incidence rates of early EL-II and persistent EL-II were 6.8% (7/103 patients) and 4.9% (5/103 patients), respectively. Aneurysm enlargement was found in 10 patients (9.7%), including all 5 patients with persistent EL-II, 3 with de novo EL-II, and 2 with no EL-II. The rates of freedom from aneurysm enlargement at 1, 2, and 3 years were 98.7%, 97.0%, and 93.1% for the group without persistent EL-II, and 80.0%, 60.0%, and 20.0% for the group with persistent EL-II (p < 0.001), respectively. The maximum aneurysm diameter (odds ratio (OR), 1.16; 95% confidence interval (CI), 1.01–1.34; p = 0.0362) and the number of patent lumbar arteries (OR, 2.72; 95% CI, 1.07–6.90; p = 0.0357) were predictive of persistent EL-II.


The incidence of EL-II after EVAR using the Endurant stent graft for AAA with occluded IMA was low, but most early EL-II persisted and resulted in aneurysm enlargement.

Level of Evidence Level 4, Case Series.


Type II endoleak Endurant Inferior mesenteric artery Prophylactic embolization 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Declaration of Helsinki 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.

Consent for Publication

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


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Tomoyuki Gentsu
    • 1
  • Takuya Okada
    • 1
  • Masato Yamaguchi
    • 1
  • Hiroki Horinouchi
    • 1
  • Naoto Katayama
    • 1
  • Eisuke Ueshima
    • 1
  • Yutaka Koide
    • 1
  • Keitaro Sofue
    • 1
  • Yasuko Gotake
    • 2
  • Yoshikatsu Nomura
    • 2
    • 3
  • Hiroshi Tanaka
    • 2
  • Yutaka Okita
    • 2
    • 4
  • Koji Sugimoto
    • 1
  • Takamichi Murakami
    • 1
  1. 1.Department of RadiologyKobe University Graduate School of MedicineKobeJapan
  2. 2.Division of Cardiovascular Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
  3. 3.Department of Cardiovascular SurgeryHyogo Brain and Heart CenterHimejiJapan
  4. 4.Department of Cardiovascular SurgeryTakatsuki General HospitalTakatsukiJapan

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