Type II endoleak: conservative management is a safe strategy
D A Sidloff1, V Gokani1, P W Stather1
1Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Summary
Type II endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) are common but often resolve spontaneously. Patients with type II endoleaks show similar aneurysm-related mortality and improved overall survival.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Management
Background:
- Type II endoleak is the most frequent complication following endovascular abdominal aortic aneurysm repair (EVAR).
- The long-term behavior and clinical significance of type II endoleaks remain incompletely understood.
Purpose of the Study:
- To investigate the incidence and clinical outcomes of type II endoleaks.
- To analyze the natural history, including spontaneous resolution and sac expansion, of type II endoleaks after EVAR at a single institution.
Main Methods:
- A prospective database of 904 patients undergoing EVAR between 1995 and 2013 was analyzed.
- Follow-up was conducted using duplex ultrasound (DUSS).
- Patients with and without type II endoleaks were compared regarding demographics, mortality, and sac expansion.
Main Results:
- 19% of patients developed type II endoleak, with 54% resolving spontaneously within 6 months.
- No significant differences in preoperative demographics or endograft choice were observed between groups.
- Patients with type II endoleak exhibited significantly higher survival rates (94.1% vs. 85.6%, p=0.01), particularly late type II endoleaks (97.7% vs. 85.6%, p=0.004).
- Aneurysm-related mortality and type I endoleak rates were similar. Freedom from >5mm sac expansion was lower in the type II endoleak group (82.5% vs. 93.2%, p=0.0001).
Conclusions:
- Isolated type II endoleaks after EVAR are associated with comparable aneurysm-related mortality.
- Patients experiencing type II endoleaks demonstrate an improved overall survival rate compared to those without endoleaks.
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