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