Abstract
Type II endoleaks are associated with the absence of aneurysm shrinkage after endovascular abdominal aortic aneurysm repair (EVAR). This study aims at determining the predictability of this complication, whose potential risk factors have been the subject of conflicting reports. Preoperative computed tomography (CT) scans of 178 patients who underwent EVAR for true infrarenal abdominal aortic aneurysms between January 20, and April 17, 2003, with a minimum follow-up of 30 days, were reviewed. The following information was retrieved: maximum aneurysm diameter, aneurysm thrombus load (maximum thickness, percentage of sac circumference wall coverage, percentage of maximum sac area occupancy); number, diameter, and nature (lumbar, inferior mesenteric, accessory renal, middle sacral) of patent aortic side-branch arteries; thrombus thickness at each aortic branch ostium, and aneurysm diameter at that level. Postoperative CT and duplex scans supplemented with angiography in selected cases were reviewed for the presence of a type II endoleak observable beyond the 30th postoperative day. Logistic regression was used to assess the association of each variable with this outcome. There were 38 (21.3%) patients with type II endoleaks after the 30th postoperative day. The median follow-up was 12 months (range 1–65 months). By univariate analysis, the following variables significantly decreased the risk of a type II endoleak: thrombus maximum thickness [odds ratio (OR) 0.77 for a 5 mm increase, p = 0.009], mean thrombus thickness at aortic side-branches ostia (OR 0.65 for a 1 mm increase, p = 0.0006), thrombus-occupied percentage of maximum aneurysm area (OR 0.72 for a 10% increase, p < 0.0001), percentage of thrombus-lined aneurysm wall (OR 0.53 for a 25% increase, p < 0.0001). The presence of a patent inferior mesenteric artery (OR 6.84, p < 0.01) and the number of patent aortic side-branches (OR 1.37 for each additional vessel, p = 0.002) significantly increased the risk of detecting a late type II endoleak. Aneurysm and aortic side-branch diameters did not have any impact. In a multiple logistic regression model (whole model p < 0.0001), the thrombus-occupied percentage of maximum aneurysm area (OR 0.74 for a 10% increase, p < 0.0005) and the number of patent aortic side-branches (OR 1.31 for each additional vessel, p = 0.009) remained independent predictors of type II endoleaks. The simple measure of the proportion of maximum aneurysm area occupied by thrombus may be a useful way to identify patients at high risk of a persistent type II endoleak. Patients with low preoperative sac thrombus load should be followed with a high degree of suspicion for this complication.
Similar content being viewed by others
References
JC Parodi JC Palmaz HD Barone (1991) ArticleTitleTransfemoral intraluminal graft implantation for abdominal aortic aneurysm Ann. Vasc. Surg. 5 491–499 Occurrence Handle1:STN:280:By2C38nks1E%3D Occurrence Handle1837729
InstitutionalAuthorNameAd Hoc Committe for Standardized Reporting Practices in Vascular Surgery of the Society for Vascular Surgery. (2002) ArticleTitleReporting standards for endovascular aortic aneurysm repair J. Vasc. Surg. 35 1048–1060
TAM Chuter RM Faruqi R Sawhney et al. (2001) ArticleTitleEndoleak after endovascular repair of abdominal aortic aneurysm J. Vasc. Surg. 34 105
FR Arko GD Rubin BL Johnson BB Hill TJ Fogarty CK Zarins (2001) ArticleTitleType-II endoleaks following endovascular AAA repair: preoperative predictors and long-term effects J. Endovasc. Ther. 8 503–510 Occurrence Handle10.1583/1545-1550(2001)008<0503:TIEFEA>2.0.CO;2 Occurrence Handle1:STN:280:DC%2BD3MnntF2gtg%3D%3D Occurrence Handle11718410
MR Back AN Bowser BL Johnson D Schmacht B Zwwiebel DF Bandyk (2003) ArticleTitlePatency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair Ann. Vasc. Surg. 17 27–34 Occurrence Handle10.1007/s10016-001-0327-x Occurrence Handle12522694
MP Armon SW Yusuf SC Whitaker RH Gregson PW Wenliam BR Hopkinson (1998) ArticleTitleThrombus distribution and changes in aneurysm size following endovascular aortic aneurysm repair Eur. J. Vasc. Endovasc. Surg. 16 472–476 Occurrence Handle1:STN:280:DyaK1M7htFymtA%3D%3D Occurrence Handle9894485
C Marrewijk JM Buth PL Harris L Norgren A Nevelsteen MG Wyatt (2002) ArticleTitleSignificance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience J. Vasc. Surg. 35 661–673 Occurrence Handle11932659
SR Vallabhaneni PL Harris (2001) ArticleTitleLessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair Eur. J. Radiol 39 34–41 Occurrence Handle1:STN:280:DC%2BD3MzosFanuw%3D%3D Occurrence Handle11439229
RA White C Donayre I Walot M Stewart (2000) ArticleTitleAbdominal aortic aneurysm rupture following endoluminal graft development: report of predictable event J. Endovasc. Ther. 7 257–262 Occurrence Handle1:STN:280:DC%2BD3M%2FltVCjug%3D%3D Occurrence Handle10958288
CZ Abraham TAM Chuter LM Reilly et al. (2002) ArticleTitleAbdominal aortic aneurysm repair with the Zenith stent graft: short to mid term results J. Vasc. Surg. 36 217–225 Occurrence Handle12170200
RJ Hinchliffe R Singh-Ranger IRH Davidson BR Opkinson (2001) ArticleTitleRupture of an abdomonal aortic aneurysm secondary to type II endoleak Eur. J. Vasc. Endovasc. Surg. 22 563–565 Occurrence Handle1:STN:280:DC%2BD3MnptFKisg%3D%3D Occurrence Handle11735209
SR Walker K Halliday SW Yusuf et al. (1998) ArticleTitleA study on the patency of of the inferior mesenteric and lumbar arteries in the incidence of endoleak following endovascular repair of infra-renal aortic aneurysms Clin. Radiol. 53 593–595 Occurrence Handle1:STN:280:DyaK1cvhsFygtg%3D%3D Occurrence Handle9744585
PV Petrik WS Moore (2000) ArticleTitleEndoleaks following endovascular repair of abdominal aortic aneurysm: the predictive value of preoperative anatomic factors—a review of 100 cases J. Vasc. Surg. 33 739–744 Occurrence Handle10.1067/mva.2001.112232
OC Velasquez RA Baum JP Carpenter et al. (2000) ArticleTitleRelatioship 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. 32 777–788 Occurrence Handle11013042
JP Duncan DO Kessel I Robertson et al. (2002) ArticleTitleType II endoleaks: predictable, preventable, and sometimes treatable? J. Vasc. Surg. 36 105–110 Occurrence Handle12096266
J Gorich N Rilinger R Sokiranski et al. (2001) ArticleTitleEndoleaks after endovascular repair of aortic aneurysm: are they predictable? Radiology 218 477–480 Occurrence Handle1:STN:280:DC%2BD3M3lvVejug%3D%3D Occurrence Handle11161165
RA Wain ML Marin T Ohki et al. (1998) ArticleTitleEndoleaks after endovascular graft treatment of aortic aneurysms; classification, risk factors and outcome J. Vasc. Surg 27 69–80 Occurrence Handle1:STN:280:DyaK1c7jsVemuw%3D%3D Occurrence Handle9474084
CK Zarins RA White KJ Hodgson D Schwarten TJ Fogarty (2000) ArticleTitleEndoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial J. Vasc. Surg. 32 90–107 Occurrence Handle1:STN:280:DC%2BD3czjs1OksQ%3D%3D Occurrence Handle10876210
SN Tuerff CB Rockman PJ Lamparello et al. (2002) ArticleTitleAre type II endoleaks really benign? Ann. Vasc. Surg. 16 50–54 Occurrence Handle11904804
Acknowledgments
The authors acknowledge the contributions of Ms. Tanya Hoskin, MS, for statistical analysis and Mrs. Rhonda Brincks for manuscript preparation.
Author information
Authors and Affiliations
Corresponding author
Additional information
Sérgio M. Sampaio is a recipient of the Edward S. Rogers Vascular Surgery Clinical Research Fellowship.
Presented at the 32nd Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery, Rancho Mirage, CA, March 10-13, 2004.
About this article
Cite this article
Sampaio, S.M., Panneton, J.M., Mozes, G.I. et al. Aneurysm Sac Thrombus Load Predicts Type II Endoleaks after Endovascular Aneurysm Repair. Ann Vasc Surg 19, 302–309 (2005). https://doi.org/10.1007/s10016-005-0002-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10016-005-0002-8