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Late rupture after EVAR: a new trend?

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Late aortic ruptures after endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA) are a concern. This study found a notable number of AAA ruptures post-EVAR, including surprising cases due to type II endoleaks.

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Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Aortic Aneurysm Management

Background:

  • Endovascular aortic repair (EVAR) is a standard treatment for abdominal aortic aneurysms (AAA).
  • Late aortic ruptures following EVAR, often due to endoleaks, remain a significant clinical challenge.

Purpose of the Study:

  • To investigate the causes of ruptured abdominal aortic aneurysms (AAA) in patients who previously underwent endovascular aortic repair (EVAR).
  • To analyze the specific types of endoleaks and their management in post-EVAR ruptured AAA cases.

Main Methods:

  • Retrospective analysis of patients treated for ruptured juxtra- or infrarenal AAA between January 2011 and October 2013.
  • Inclusion criteria focused on patients with a history of prior EVAR presenting with AAA rupture.

Main Results:

  • Six out of 30 patients with ruptured AAA had prior EVAR.
  • The median time from EVAR to rupture was 42.5 months.
  • Ruptures were attributed to type Ia (n=3), type II (n=2), and type III (n=1) endoleaks, with varied interventional strategies.

Conclusions:

  • A considerable number of ruptured AAA cases were observed in patients with prior EVAR.
  • Type II endoleaks were a surprising cause of rupture in this post-EVAR cohort.
  • Effective management strategies for endoleak-related ruptures post-EVAR are crucial.