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Related Experiment Videos

Type II endoleaks: predictable, preventable, and sometimes treatable?

Duncan J Parry1, David O Kessel, Iain Robertson

  • 1Department of Vascular Surgery, St James's University Teaching Hospital, Leeds Teaching Hospitals, United Kingdom.

Journal of Vascular Surgery
|July 4, 2002
PubMed
Summary

Preoperative coil embolization of lumbar and inferior mesenteric arteries effectively prevents type II endoleaks after endovascular aneurysm repair, leading to better sac shrinkage. This intervention is crucial for improving outcomes in aortic aneurysm treatment.

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Medical Imaging

Background:

  • Type II endoleaks are a common complication after endovascular aneurysm repair (EVAR).
  • These endoleaks arise from patent aortic side branches, such as lumbar and inferior mesenteric arteries.
  • Persistent endoleaks can compromise the long-term success of EVAR.

Purpose of the Study:

  • To evaluate the efficacy of preoperative coil embolization of lumbar and inferior mesenteric arteries.
  • To determine the impact of this embolization on the incidence of type II endoleaks post-EVAR.
  • To assess the effect on aortic sac diameter changes after EVAR.

Main Methods:

  • Retrospective analysis of patients undergoing EVAR between 1996 and 2001.
  • Identification of patent aortic side branches using CT angiography and calibrated angiography.

Related Experiment Videos

  • Pre-EVAR coil embolization of identified arteries.
  • Follow-up with imaging (radiographs, ultrasound, CT scans) and digital subtraction angiography when needed.

    • Main Results:

    • None of the patients who underwent preoperative embolization developed type II endoleaks.
    • In contrast, 62% of patients with patent lumbar arteries without embolization developed endoleaks (P =.006).
    • A significant median reduction in aortic sac diameter was observed in the absence of type II endoleaks (3.0 mm, P =.002).

    Conclusions:

    • Type II endoleaks are predictable and preventable with preoperative embolization.
    • Preoperative coil embolization is an effective strategy to reduce type II endoleak incidence.
    • Absence of type II endoleak is associated with significant aortic sac shrinkage post-EVAR.