Embolisation of Type 2 Endoleaks Associated with Sac Expansion-Outcomes from a Single-Centre Cohort

To describe the outcomes of a patient cohort following transcatheter embolisation for type 2 endoleaks associated with sac expansion.

A retrospective single-centre observational study was performed between September 2005 and June 2023. Technical success rates and long-term outcomes were evaluated including technical factors associated with endoleak recurrence and rupture. One hundred transcatheter embolisations were performed for type 2 endoleaks in 72 patients (64 male and 8 female).

Technical success (cessation of flow in the endoleak on angiography) was achieved in 77/100 (77%) procedures. Clinical success (freedom from sac growth on surveillance) was achieved in 82% at 12 months, 70% at 24 months and 59% at 60 months. Persistent endoleaks were found in 27%, with 7% developing a new type 2 and 14% developing new type 1, 3 or 5 endoleaks. The rupture rate was 7%, including 2/7 persistent type 2 endoleaks, 4/7 new type 1 or 3 endoleaks and 1/7 type 5 endoleak. Embolisation was performed either via a transarterial route (74%) or via direct sac puncture (24%), the latter demonstrating a significant correlation with technical success (p=0.018).

This study confirms the importance of embolisation as the main treatment modality of type 2 endoleaks with freedom from sac growth achieved in 70% of patients at 24 months. However, this remains a complex entity with persistent sac growth, risking the development of type 1 or 3 endoleaks, which carry a risk of late sac rupture.