Midterm Outcomes After Treatment of Type II Endoleaks Associated With Aneurysm Sac Expansion

被引:62
|
作者
Gallagher, Katherine A. [1 ]
Ravin, Reid A. [2 ]
Meltzer, Andrew J. [2 ,3 ]
Khan, Asad [3 ]
Coleman, Dawn M. [1 ]
Graham, Ashley R. [3 ]
Aiello, Francesco [2 ,3 ]
Shrikhande, Gautam [2 ]
Connolly, Peter H. [3 ]
Dayal, Rajeev [2 ]
Karwowski, John K. [3 ]
机构
[1] Univ Michigan Hosp, Ann Arbor, MI 48109 USA
[2] New York Presbyterian Columbia Univ Med Ctr, New York, NY USA
[3] New York Presbyterian Weill Cornell Med Ctr, New York, NY USA
关键词
endovascular aneurysm repair; abdominal aortic aneurysm; endoleak; type II endoleak; sac expansion; lumbar arteries; inferior mesenteric artery; coil embolization; outcome analysis; ABDOMINAL AORTIC-ANEURYSM; INFERIOR MESENTERIC-ARTERY; ENDOVASCULAR REPAIR; FOLLOW-UP; COIL EMBOLIZATION; NATURAL-HISTORY; CANINE MODEL; MANAGEMENT; FREQUENCY; RUPTURE;
D O I
10.1583/11-3653.1
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose: To examine the outcomes following interventions for type II endoleaks in patients with aneurysm sac expansion after endovascular aneurysm repair (EVAR). Methods: A retrospective review was conducted of all patients who underwent treatment for type II endoleak from July 2001 to September 2010 in a single center. In this time period, 29 (4.7%) patients (22 men; mean age 78.6 years, range 54-87) were identified as having a type II endoleak and enlargement of the aneurysm sac, meeting the criterion for treatment. All patients had at least one attempted percutaneous intervention. Patients were followed both clinically and radiographically, with computed tomographic angiography every 3 to 12 months, over a follow-up period that ranged from 1 to 10 years (mean 3.5). Results: Forty-eight interventions were performed on the 29 patients. Of these, 15 (56%) patients underwent multiple (2-4) procedures. Of the 11 endoleaks with an isolated inferior mesenteric artery identified as the source, initial success for transarterial embolization at 2 years was 72%, with 2 of the failures having successful secondary interventions. For the 18 endoleaks with a lumbar source, the success of the initial intervention was 17% at 2 years; repeated embolization attempts produced a 40% secondary success rate. Seven (24%) patients had continued endoleak despite multiple treatment attempts; 3 ultimately required elective aortic graft explantation. There were no ruptures or deaths during the study period. In a comparison of type II endoleak patients who had stable aneurysm sacs and those who had persistent sac expansion, the only significant differences in preoperative anatomical characteristics were a lower prevalence of mural thrombus (p=0.036) and longer right iliac arteries (p=0.012) in the group with sac expansion. Independent predictors of type ll endoleak were mural thrombus (p<0.001), patent lumbar arteries (p=0.004), aneurysm length (p=0.011), and iliac artery length (p=0.004) Conclusion: This study demonstrates that most patients require multiple reinterventions to treat type ll endoleaks; specifically, lumbar artery embolization carries a low midterm success rate. J Endovasc Ther. 2012;19:182-192
引用
收藏
页码:182 / 192
页数:11
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