Preoperative predictive factors for type II endoleak: Trying to define high-risk patients

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Management

Background:

• Type 2 endoleaks (T2E) remain a significant complication of endovascular aneurysm repair (EVAR).
• Identifying preoperative risk factors for T2E is crucial for improving patient outcomes.
• Current strategies for preventing T2E are not standardized.

Purpose of the Study:

• To analyze preoperative factors in patients undergoing EVAR to identify risk factors for T2E.
• To define a high-risk patient group for T2E.
• To inform potential prophylactic interventions.

Main Methods:

• Retrospective analysis of 140 patients who underwent EVAR between January 2015 and June 2020.
• Preoperative clinical and anatomical variables were assessed.
• Statistical analysis including t-test, Mann-Whitney U test, Fisher exact test, and ROC curves were used to identify predictive factors for T2E.

Main Results:

• T2E occurred in 11.43% of patients, with 75% being persistent and 62.5% causing sac enlargement.
• Predictive factors for T2E included larger internal mesenteric artery (IMA) diameter (p < 0.001) and increased number of patent lumbar arteries (LA) (p < 0.001).
• ROC analysis identified IMA diameter > 3.5 mm and > 5 patent LA as significant risk factors for T2E.

Conclusions:

• Preoperative embolization of aortic side branches to prevent T2E is not yet a standard procedure.
• Patients with preoperative IMA > 3 mm and > 5 patent LA should be considered for pre-EVAR embolization.
• These findings help define a high-risk group for T2E, guiding potential preventative strategies.