Impact of Isolated Type 2 Endoleak on Subsequent Cardiovascular Events and Mortality

Assess subsequent cardiovascular events and all-cause mortality in patients with intact abdominal aortic aneurysm (AAA) treated by endovascular aneurysm repair (EVAR) according to the existence of isolated endoleak type 2 (EL₂) at 1 year after EVAR implantation.

This retrospective, single-center study included patients treated with EVAR between 2010 and 2017 in the vascular surgery department of the University Hospital of Lyon with an infrarenal AAA > 50 mm. The baseline clinical characteristics collected just before EVAR were retrieved from electronic patient records of our institution. AAA characteristics, procedure, and the 1-year postoperative computed tomography angiography (CTA) were reported. Study end points, major adverse cardiovascular events (MACE), major adverse lower-extremity events (MALE), and all-cause mortality were recorded during follow-up. Patients were divided into 2 groups according to the presence of isolated EL₂ (EL₂ +) or absence (EL₂ -) of any endoleak on CTA at 1 year. MACE, MALE, and all-cause mortality were compared between both groups.

During the study period, 589 patients were treated by endovascular surgery and 207 were included. According to the CTA results at 1 year, 60 patients (29%) were included in the EL₂ + group and 147 patients (71%) in the EL₂ - group. A total of 109 patients (53%) experienced a MACE or MALE; significantly fewer patients in the EL₂ + than in the EL₂ - group did so (P = 0.009). There were 47 patients (23%) who experienced at least 1 MALE, and the frequency was significantly lower in the EL₂ + group (P = 0.017).

Patients with AAA treated by EVAR who did not develop EL₂ at 1 year were at higher risk of MALE during follow-up. This might be explained by more frequent symptomatic lower extremity peripheral arterial disease at baseline in this group. These patients therefore require a closer follow-up and strict control of cardiovascular risk factors to prevent cardiovascular morbi-mortality.