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Anatomic Risk Factors for Type-2 Endoleak Following EVAR: A Retrospective Review of Preoperative CT Angiography in 326 patients

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Abstract

Purpose

We describe the anatomic characteristics on preoperative CT angiography (CTA) that predispose to type-2 endoleaks after endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysms (AAA).

Methods

Between 1999 and 2010, 326 patients had a CTA before and after EVAR. CTAs were reviewed for maximal sac diameter, >50 % circumferential luminal thrombus, and patency of the infrarenal aortic side branches, including the inferior mesenteric artery (IMA) and L2-L5 lumbar arteries. Postoperative CTAs were reviewed for a persistent type-2 endoleak.

Results

Of 326 patients, 30.4 % had a type-2 endoleak on CTA. Univariate analysis demonstrated a patent IMA, increased patent individual L2, L3, and L4 lumbar arteries, and an increased number of total patent lumbar arteries in patients with type-2 endoleak compared to those without (p < 0.001, 0.002, <0.001, <0.001, and <0.001 respectively). Sac diameter, patent L5 lumbar arteries, and >50 % circumferential mural thrombus were not significantly different (p = 0.652, 0.617, and 0.16). Univariate logistic regression demonstrated increased risk of endoleak with each additional patent lumbar artery (odds ratio (OR) 1.26, p < 0.001). Multivariate analysis of the 326 patients resulted in the delineation of the optimal anatomic variables that predicted a type-2 endoleak: occluded L3 lumbar arteries (OR 0.1, p = 0.002), occluded L4 lumbar vertebral arteries (OR 0.31, p = 0.034), and IMA occlusion (OR 0.38, p = 0.008).

Conclusions

Univariate analysis demonstrated total patent lumbar arteries as a significant predictor of type-2 endoleak. Multivariate analysis demonstrated IMA occlusion, L3 lumbar artery occlusion, and L4 lumbar artery occlusion as independently protective against type-2 endoleak after EVAR.

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Acknowledgements

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Conflict of interest

Thomas J Ward, None; Stuart Cohen, None; Rahul S Patel, Consultant: Arstasis, Sirtex; Edward Kim, Industry sponsored lectures: Philips Healthcare; Aaron M Fischman, None; Francis S Nowakowski, None; Sharif Ellozy, Scientific Advisory Board: LeMaitre Vascular, Lombard Medical. Industry sponsored lectures: Medtronic; Peter L Faries, Scientific Advisory Board: Medtronic. Consulting: Merck, ev3. Michael L Marin, Consulting: Medtronic; Robert A Lookstein Consulting: Cordis, MEDRAD. Industry sponsored lectures: Boston Scientific. Scientific Advisory Board: Boston Scientific.

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Authors and Affiliations

  1. Department of Interventional Radiology, Mount Sinai Medical Center, One Gustave L Levy Place, New York, NY, 10029, USA

    Thomas J. Ward, Stuart Cohen, Rahul S. Patel, Edward Kim, Aaron M. Fischman, Francis S. Nowakowski & Robert A. Lookstein

  2. Department of Vascular Surgery, Mount Sinai Medical Center, One Gustave L Levy Place, New York, NY, USA

    Sharif H. Ellozy, Peter L. Faries & Michael L. Marin

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  1. Thomas J. Ward
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  2. Stuart Cohen
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  3. Rahul S. Patel
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  10. Robert A. Lookstein
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Correspondence to Thomas J. Ward.

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Ward, T.J., Cohen, S., Patel, R.S. et al. Anatomic Risk Factors for Type-2 Endoleak Following EVAR: A Retrospective Review of Preoperative CT Angiography in 326 patients. Cardiovasc Intervent Radiol 37, 324–328 (2014). https://doi.org/10.1007/s00270-013-0646-7

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  • DOI: https://doi.org/10.1007/s00270-013-0646-7

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