Advertisement

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
  • 38 Downloads
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Purpose

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.

Results

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.

Conclusions

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.

Keywords

Type II endoleak Endurant Inferior mesenteric artery Prophylactic embolization 

Notes

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.

References

  1. 1.
    Guo Q, Du X, Zhao J, Ma Y, Huang B, Yuan D, et al. Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: a meta-analysis. PLoS ONE. 2017;12(2):1–13.Google Scholar
  2. 2.
    Sidloff DA, Stather PW, Choke E, Bown MJ, Sayers RD. Type II endoleak after endovascular aneurysm repair. Br J Surg. 2013;100:1262–70.CrossRefGoogle Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    van Marrewijk CJ, Fransen G, Laheij RJF, Harris PL, Buth J. 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(12):128–37.CrossRefGoogle Scholar
  5. 5.
    Cieri E, De Rango P, Isernia G, Simonte G, Ciucci A, Parlani G, et al. Type II endoleak is an enigmatic and unpredictable marker of worse outcome after endovascular aneurysm repair. J Vasc Surg. 2014;59(4):930–7.CrossRefGoogle Scholar
  6. 6.
    Ward TJ, Cohen S, Fischman AM, Kim E, Nowakowski FS, Ellozy SH, et al. Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: Decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol. 2013;24(1):49–55.CrossRefGoogle Scholar
  7. 7.
    Burbelko M, Kalinowski M, Heverhagen JT, Piechowiak E, Kiessling A, Figiel J, et al. Prevention of type II endoleak using the AMPLATZER vascular plug before endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2014;47(1):28–36.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Müller-Wille R, Uller W, Gößmann H, Heiss P, Wiggermann P, Dollinger M, et al. Inferior mesenteric artery embolization before endovascular aortic aneurysm repair using amplatzer vascular plug type 4. Cardiovasc Intervent Radiol. 2014;37(4):928–34.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Nevala T, Biancari F, Manninen H, Matsi P, Mäkinen K, Ylönen K, et al. Inferior mesenteric artery embolization before endovascular repair of an abdominal aortic aneurysm: Effect on type II endoleak and aneurysm shrinkage. J Vasc Interv Radiol. 2010;21(2):181–5.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Manunga JM, Cragg A, Garberich R, Urbach JA, Skeik N, Alexander J, et al. Preoperative inferior mesenteric artery embolization: a valid method to reduce the rate of type II endoleak after EVAR? Ann Vasc Surg. 2017;39:40–7.CrossRefGoogle Scholar
  11. 11.
    Axelrod DJ, Lookstein RA, Guller J, Nowakowski FS, Ellozy S, Carroccio A, et al. Inferior mesenteric artery embolization before endovascular aneurysm repair: technique and initial results. J Vasc Interv Radiol. 2004;15(11):1263–7.CrossRefGoogle Scholar
  12. 12.
    Lo RC, Buck DB, Herrmann J, Hamdan AD, Wyers M, Patel VI, et al. Risk factors and consequences of persistent type II endoleaks. J Vasc Surg. 2016;63(4):895–901.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sheehan MK, Ouriel K, Greenberg R, McCann R, Murphy M, Fillinger M, et al. Are type II endoleaks after endovascular aneurysm repair endograft dependent? J Vasc Surg. 2006;43(4):657–61.CrossRefGoogle Scholar
  14. 14.
    Ouriel K, Clair DG, Greenberg RK, Lyden SP, O’Hara PJ, Sarac TP, et al. Endovascular repair of abdominal aortic aneurysms: Device-specific outcome. J Vasc Surg. 2016;37(5):991–8.CrossRefGoogle Scholar
  15. 15.
    Singh MJ, Fairman R, Anain P, Jordan WD, Maldonaldo T, Samson R, et al. Final results of the Endurant Stent Graft System in the United States regulatory trial. J Vasc Surg. 2016;64(1):55–62.CrossRefGoogle Scholar
  16. 16.
    Kvinlaug KE, Lawlor DK, Forbes TL, Willoughby R, MacKenzie KS, DeRose G, et al. Early results from a Canadian multicenter prospective registry of the Endurant stent graft for endovascular treatment of abdominal aortic aneurysms. J Endovasc Ther. 2012;19(1):58–66.CrossRefGoogle Scholar
  17. 17.
    Stokmans RA, Teijink JAW, Forbes TL, Böckler D, Peeters PJ, Riambau V, et al. Early results from the ENGAGE registry: real-world performance of the Endurant Stent Graft for endovascular AAA repair in 1262 patients. Eur J Vasc Endovasc Surg. 2012;44(4):369–75.CrossRefGoogle Scholar
  18. 18.
    Rouwet EV, Torsello G, de Vries JP, Cuypers P, van Herwaarden JA, Eckstein HH, et al. Final results of the prospective European trial of the Endurant stent graft for endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2011;42(4):489–97.CrossRefGoogle Scholar
  19. 19.
    Van Keulen JW, De Vries JPPM, Dekker H, Gonalves FB, Moll FL, Verhagen HJ, et al. One-year multicenter results of 100 abdominal aortic aneurysm patients treated with the Endurant stent graft. J Vasc Surg. 2011;54(3):609–15.CrossRefGoogle Scholar
  20. 20.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.CrossRefGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    Hongo N, Kiyosue H, Shuto R, Kamei N, Miyamoto S, Tanoue S, et al. Double coaxial microcatheter technique for transarterial aneurysm sac embolization of type II endoleaks after endovascular abdominal aortic repair. J Vasc Interv Radiol. 2014;25(5):709–16.CrossRefPubMedGoogle Scholar
  23. 23.
    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):1299–302.CrossRefPubMedGoogle Scholar
  24. 24.
    Jouhannet C, Alsac JM, Julia P, Sapoval M, El Batti S, Di Primio M, et al. Reinterventions for type 2 endoleaks with enlargement of the aneurismal sac after endovascular treatment of abdominal aortic aneurysms. Ann Vasc Surg. 2014;28(1):192–200.CrossRefPubMedGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    Samura M, Morikage N, Mizoguchi T, Takeuchi Y, Ueda K, Harada T, et al. Identification of anatomical risk factors for type II endoleak to guide selective inferior mesenteric artery embolization. Ann Vasc Surg. 2018;48:166–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Ward TJ, Cohen S, Patel RS, Kim E, Fischman AM, Nowakowski FS, et al. Anatomic risk factors for type-2 endoleak following EVAR: a retrospective review of preoperative CT angiography in 326 patients. Cardiovasc Intervent Radiol. 2014;37(2):324–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Abularrage CJ, Crawford RS, Conrad MF, Lee H, Kwolek CJ, Brewster DC, et al. Preoperative variables predict persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg. 2010;52(1):19–24.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Velazquez OC, Baum RA, Carpenter JP, Golden MA, Cohn M, Pyeron A, et al. Relationship between preoperative patency of the inferior mesenteric artery and subsequent occurrence of type II endoleak in patients undergoing endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000;32(4):777–88.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Guntner O, Zeman F, Wohlgemuth WA, Heiss P, Jung EM, Wiggermann P, et al. Inferior mesenteric arterial type II endoleaks after endovascular repair of abdominal aortic aneurysm: Are they predictable? Radiology. 2014;270(3):910–9.CrossRefGoogle Scholar
  31. 31.
    Mursalin R, Sakamoto I, Nagayama H, Sueyoshi E, Tanigawa K, Miura T, et al. Imaging-based predictors of persistent Type II endoleak after endovascular abdominal aortic aneurysm repair. Am J Roentgenol. 2016;206(6):1335–40.CrossRefGoogle Scholar
  32. 32.
    Poublon CG, Holewijn S, van Sterkenburg SMM, Tielliu IFJ, Zeebregts CJ, Reijnen MMPJ. Long-term outcome of the GORE EXCLUDER AAA endoprosthesis for treatment of infrarenal aortic aneurysms. J Vasc Interv Radiol. 2017;28(5):637–44.CrossRefGoogle Scholar
  33. 33.
    Parent FN, Meier GH, Godziachvili V, LeSar CJ, Parker FM, Carter KA, 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(3):474–81.CrossRefGoogle Scholar
  34. 34.
    Aburahma AF, Mousa AY, Campbell JE, Stone PA, Hass SM, Nanjundappa A, et al. The relationship of preoperative thrombus load and location to the development of type II endoleak and sac regression. J Vasc Surg. 2011;53(6):1534–41.CrossRefGoogle Scholar
  35. 35.
    Müller-Wille R, Schötz S, Zeman F, Uller W, Güntner O, Pfister K, et al. CT features of early type II endoleaks after endovascular repair of abdominal aortic aneurysms help predict aneurysm sac enlargement. Radiology. 2015;274(3):906–16.CrossRefGoogle Scholar
  36. 36.
    Seike Y, Tanaka H, Fukuda T, Itonaga T, Morita Y, Oda T, et al. Influence of warfarin therapy on the occurrence of postoperative endoleaks and aneurysm sac enlargement after endovascular abdominal aortic aneurysm repair. Interact Cardiovasc Thorac Surg. 2017;24(4):615–8.Google Scholar
  37. 37.
    Marchiori A, von Ristow A, Guimaraes M, Schönholz C, Uflacker R. Predictive factors for the development of Type II endoleaks. J Endovasc Ther. 2011;18(3):299–305.CrossRefGoogle Scholar
  38. 38.
    Couchet G, Pereira B, Carrieres C, Maumias T, Ribal JP, Ben Ahmed S, et al. Predictive factors for type II endoleaks after treatment of abdominal aortic aneurysm by conventional endovascular aneurysm repair. Ann Vasc Surg. 2015;29(8):1673–9.CrossRefGoogle Scholar
  39. 39.
    Alerci M, Giamboni A, Wyttenbach R, Porretta AP, Antonucci F, Bogen M, et al. Endovascular abdominal aneurysm repair and impact of systematic preoperative embolization of collateral arteries: endoleak analysis and long-term follow-up. J Endovasc Ther. 2013;20(5):663–71.CrossRefGoogle Scholar
  40. 40.
    Lehti L, Nyman U, Söderberg M, Rses KB, Gottsäter A, Lius JW. 80-kVp CT angiography for endovascular aneurysm repair follow-up with halved contrast medium dose and preserved diagnostic quality. Acta Radiol. 2016;57:279–86.CrossRefPubMedGoogle Scholar
  41. 41.
    Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256:32–61.CrossRefPubMedGoogle Scholar

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

Personalised recommendations