Predictors for Type 2 Endoleak Requiring Embolization: Large Inferior Mesenteric Artery, Multiple Lumbar Arteries,...

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Aortic Aneurysm Management

Background:

• Endovascular abdominal aortic aneurysm repair (EVAR) is a primary AAA treatment, but lifelong surveillance is crucial due to endoleaks.
• Type II endoleaks (T2E) are a common endoleak type, with their optimal management remaining controversial.
• Identifying predictors for T2E intervention is essential for refining surveillance and treatment strategies.

Purpose of the Study:

• To identify factors predicting the need for intervention in patients with T2E following EVAR.
• To compare outcomes between T2E patients who underwent intervention (intT2E) and those who did not (nointT2E).
• To analyze the association between specific anatomical features and T2E intervention.

Main Methods:

• Retrospective review of 207 EVAR patients from 2011-2024, identifying T2E on CT angiography.
• Patients categorized into intT2E and nointT2E groups; time-to-event analysis using Cox regression.
• Logistic regression and Kaplan-Meier curves used to assess predictors (e.g., IMA size) and freedom from intervention.

Main Results:

• 78 patients (37.6%) developed T2E; 19 (24.3%) required intervention.
• Intervention was associated with younger age, anticoagulation use, larger IMAs (>4 mm), and more lumbar arteries.
• IMA >4 mm (OR 23.4) was the strongest predictor of intervention; sac growth was greater in intT2E patients.

Conclusions:

• Approximately one-quarter of T2E patients required intervention, with IMA size >4 mm being a significant predictor.
• Anticoagulation use and increased lumbar artery count also correlated with higher intervention rates.
• Risk-stratified surveillance and selective intervention are recommended for managing T2E post-EVAR.