Ten-year single-centre experience with type II endoleaks: Intervention versus observation

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Aneurysm Management

Background:

• Type II endoleaks (T2Ls) are a common complication after infra-renal endovascular aneurysm repair (IR-EVAR).
• Management strategies range from observation to various interventional approaches.

Purpose of the Study:

• To compare the outcomes of intervention versus conservative management for T2Ls.
• To evaluate the effectiveness of different interventional approaches (transarterial and translumbar).

Main Methods:

• Retrospective analysis of 386 IR-EVAR patients from 2006-2015.
• Analysis of annual surveillance imaging and multidisciplinary team meeting decisions.
• Comparison of outcomes between treated (28 patients) and conservatively managed (53 patients) T2Ls.

Main Results:

• T2Ls developed in 21.0% of patients.
• Intervention for T2Ls was associated with a higher recurrence rate (p=0.032).
• T2Ls with associated aneurysm growth were more resistant to treatment (p=0.033) but did not increase mortality.
• No significant difference in success rates between transarterial and translumbar approaches (p=0.525).
• No survival advantage for intervention over conservative management (p=0.449).

Conclusions:

• Conservative management is a viable option for T2Ls.
• T2Ls with aneurysm growth may represent an aggressive phenotype but do not necessarily increase mortality.
• Neither transarterial nor translumbar intervention offers superiority in treating T2Ls.