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Strategies of endoleak management following endoluminal treatment of abdominal aortic aneurysms in 95 patients: how, when and why

Strategie di trattamento degli endoleak dopo esclusione di aneurisma dell’aorta addominale mediante endoprotesi in 95 pazienti: come, quando e perché

La radiologia medica volume 113, pages 1029–1042 (2008)Cite this article

Abstract

Purpose

This study reviews, on the basis of our experience, the indications and options for treating endoleaks (EL) after endovascular repair of abdominal aortic aneurysms (AAA) by endografting.

Materials and methods

Ninety-five patients (M/F =92/3; mean age at time of operation 70.7±7.8 years) who underwent endovascular repair of infrarenal AAA between April 1997 and October 2004 were considered. All images of 420 pre-and postoperative computed tomography (CT) studies were reviewed.

Results

A total of 37 EL occurred in 33/95 patients (34.7%), four of whom had two EL of different types. Eighteen EL were treated, 16 by endoluminal treatment. Six EL were type I: 2 were treated by percutaneous transluminal angioplasty (PTA) and 4 by cuff deployment (2 proximal cuffs and 2 distal cuffs). Eight EL were type II: 2 were treated by PTA, 2 by cuff deployment, 1 by transcatheter coil embolisation of the inferior mesenteric artery, two by thrombin injection in the aneurysm sac and one underwent surgical conversion during an attempt to treat a concomitant type I EL. Finally, 2 EL were type III: 1 was treated by PTA and 1 by cuff deployment. Endovascular treatment was successful in 12/16 cases (75%), whereas 3/16 cases (18.8%) were converted to open surgery, and 1 patient died of AAA rupture the day after endovascular repair.

Conclusions

EL is the most common complication after endovascular repair of AAA. In type I and type III EL, treatment is mandatory, whereas in type II (and type V) EL, treatment is indicated in the presence of AAA enlargement. Type IV EL generally disappear spontaneously. Endovascular repair is feasible and can be performed with different techniques according to EL aetiology, but it is not always decisive, and in some cases surgical conversion is required.

Riassunto

Obiettivo

Revisionare, in base alla nostra esperienza, le indicazioni e le opzioni terapeutiche per il trattamento degli endoleak (EL) successivi al trattamento endovascolare degli aneurismi dell’aorta addominale (AAA) mediante endoprotesi (EP).

Materiali e metodi

Sono stati considerati retrospettivamente 95 pazienti consecutivi (M/F=92/3; età media al momento dell’impianto 70,7±7,8 anni) sottoposti nel periodo aprile 1997-ottobre 2004 ad impianto di EP per esclusione di AAA infrarenale. Sono state revisionate le immagini di 420 esami TC eseguiti sia in fase preoperatoria che postoperatoria.

Risultati

In 33/95 (34,7%) dei pazienti si sono verificati complessivamente 37 EL, essendovi stati 4 pazienti con 2 EL di tipo diverso. Fra questi, 18 EL hanno richiesto trattamento, di cui 16 per via endovascolare. Sei EL erano di tipo I: 2 sono stati trattati con PTA e 4 con il posizionamento di cuffie (2 prossimali e 2 distali). Otto EL erano di tipo II: 2 sono stati trattati con PTA, 2 con il posizionamento di una cuffia iliaca, 1 con embolizzazione transcatetere dell’arteria mesenterica inferiore, 2 con iniezione di trombina all’interno della sacca aneurismatica e in un caso, associato anche ad EL di tipo I, nel tentativo di trattamento di quest’ultimo, si è ricorsi a conversione chirurgica. Infine 2 EL erano di tipo III: 1 è stato trattato con PTA e 1 con il posizionamento di una cuffia iliaca. Il tasso di successo tecnico è stato del 75% (12/16 EL), essendovi stata necessità di conversione chirurgica in 3/16 casi (18,8%) ed essendo un paziente deceduto il giorno successivo al trattamento endovascolare per rottura dell’AAA.

Conclusioni

L’EL rappresenta una delle complicanze più frequenti dopo trattamento endovascolare di AAA. Sono sempre candidati al trattamento gli EL graft-correlati (tipi I e III), mentre gli EL di tipo II (e tipo V) devono essere trattati solo se associati a crescita dimensionale dell’AAA. Gli EL di tipo IV solitamente si risolvono con regressione spontanea. Il trattamento endovascolare è possibile secondo diverse modalità in base all’eziologia dell’EL, ma non sempre è risolutivo e talvolta è necessario ricorrere alla conversione chirurgica.

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Affiliations

  1. Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali, Sezione di Radiologia, Università di Padova, Padova, Italy

    G. Barbiero, A. Baratto, F. Ferro, J. Dall’Acqua, C. Fittà & D. Miotto

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  1. G. Barbiero
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  2. A. Baratto
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  3. F. Ferro
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  4. J. Dall’Acqua
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  5. C. Fittà
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  6. D. Miotto
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Correspondence to G. Barbiero.

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Barbiero, G., Baratto, A., Ferro, F. et al. Strategies of endoleak management following endoluminal treatment of abdominal aortic aneurysms in 95 patients: how, when and why. Radiol med 113, 1029–1042 (2008). https://doi.org/10.1007/s11547-008-0317-y

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Keywords

  • Abdominal aortic aneurysm
  • Endovascular treatment
  • Endoleak
  • Endograft

Parole chiave

  • Aneurima aortico addominale
  • Trattamento endovascolare
  • Endoleak
  • Endoprotesi