Risk Factors for Type 2 Endoleak After Preemptive Side Branch Embolization During EVAR for Abdominal Aortic Aneurysm

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Type 2 endoleak (T2EL) is the most frequent complication following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA).
• T2EL is linked to sac enlargement and adverse late events.
• Preemptive embolization of aortic side branches is a strategy to mitigate T2EL incidence.

Purpose of the Study:

• To evaluate mid-term outcomes of EVAR with preemptive side branch embolization (PBE).
• To identify factors associated with persistent T2EL after EVAR with PBE.

Main Methods:

• Retrospective review of 217 patients undergoing EVAR with PBE (inferior mesenteric artery and lumbar arteries).
• Analysis of patient characteristics, aneurysm morphology, and procedural details.
• Logistic regression used to identify risk factors for T2EL.

Main Results:

• T2EL occurred in 11.5% of patients during a mean follow-up of 43 months.
• Sac enlargement was significantly more frequent in patients with T2EL (36.0% vs. 4.7%).
• Angulated neck anatomy (OR 2.90) and number of residual lumbar arteries (OR 1.74) were independent predictors of T2EL.

Conclusions:

• Persistent T2EL after PBE is associated with unfavorable sac behavior and increased reintervention rates.
• Residual lumbar arteries and angulated neck anatomy independently predict persistent T2EL.
• Complete embolization is crucial, especially in patients with angulated neck anatomy.