Type 2 Endoleaks: Common and Hard to Eradicate yet Benign?

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Management

Background:

• Type 2 endoleaks (T2ELs) following endovascular abdominal aortic aneurysm repair (EVAR) present diagnostic and therapeutic challenges.
• The clinical significance and optimal management strategies for T2ELs remain under investigation.

Purpose of the Study:

• To report the experience of managing type 2 endoleaks (T2ELs) after EVAR in a tertiary Asian center.
• To evaluate the incidence, natural history, and outcomes of interventions for T2ELs.

Main Methods:

• Retrospective analysis of patients undergoing EVAR between 2006 and 2016.
• Identification and data analysis of patients who developed T2ELs, including early vs. late onset and isolated vs. concomitant endoleaks.
• Evaluation of spontaneous resolution, surveillance, and intervention outcomes (embolization) for persistent T2ELs associated with sac growth.

Main Results:

• 67 out of 156 (42.9%) EVAR patients developed T2ELs, with 56.7% occurring early.
• Spontaneous resolution was observed in 41.7% of T2ELs.
• Intervention for persistent T2ELs with sac growth (n=17) had a 75% technical success rate, but only 35.7% achieved complete and sustained resolution; 2 deaths occurred due to sac rupture in patients with concomitant T1EL/T3EL.

Conclusions:

• Type 2 endoleaks (T2ELs) are a frequent complication after EVAR.
• Isolated T2ELs without sac growth are generally benign and amenable to surveillance.
• Interventions for T2ELs with sac growth show limited efficacy in achieving complete resolution, even with reinterventions.