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. 2023 Jul 25;33(4):282-287.
doi: 10.1055/s-0043-1771344. eCollection 2024 Dec.

Incidence and Long-Term Implications of Type 2 Endoleak after Endovascular Repair of Abdominal Aortic and Aortoiliac Aneurysms

Nicola Monzio-Compagnoni  1   2 , Gianmarco Zuccon  3   4 , Fabiane Barbosa  3 , Antonio Gaetano Rampoldi  3 , Valerio Stefano Tolva  1   2
Affiliations

Incidence and Long-Term Implications of Type 2 Endoleak after Endovascular Repair of Abdominal Aortic and Aortoiliac Aneurysms

Nicola Monzio-Compagnoni et al. Int J Angiol. .

Abstract

Type 2 endoleak has been proved not to significantly increase the risk of aneurysm rupture. However, it is associated with aneurysm enlargement and may require secondary interventions. Its role has been widely investigated, but a definitive consensus about its management has still not been obtained. We performed a retrospective, single-center observational study that investigates the incidence of type 2 endoleak and its implications in the long-term follow-up in all the patients who underwent endovascular aortic repair (EVAR) for abdominal aortic aneurysm from 2011 to 2016 at our institution. A total of 216 patients who underwent EVAR during the specified time period were enrolled, and 85 of them (39%) developed type 2 endoleak in their follow-up. Thirty-one of the patients who developed type 2 endoleak faced an aneurysm sac growth > 10 mm and required secondary intervention. Only nine of them showed resolution of the leak. In the long-term follow-up, patients who developed type 2 endoleak after EVAR did not show a significantly increased mortality compared with those who did not, but some of them required late open conversion due to aneurysm sac enlargement and some other developed a secondary type 1 endoleak which required correction. The management of type 2 endoleak remains debated, despite consensus exist regarding the need for intervention when a > 10-mm aneurysm sac growth is observed. Further studies are necessary to better define which are the "high-risk" type 2 endoleaks and identify the patients who would benefit more from correction.

Keywords: abdominal aortic aneurysm; aneurysm; coil embolization; endograft placement; endovascular procedure; endovascular repair; iliac artery disease.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves of patients who did or did not develop type 2 endoleak in the long-term follow-up after endovascular aortic repair of abdominal aortic or aortoiliac aneurysms.
Fig. 2
Fig. 2
Embolization of type 2 endoleak through the superior mesenteric artery. Through right arterial femoral percutaneous access, the superior mesenteric artery is engaged with a Cobra 5 Fr catheter. A microcatheter is then used to navigate the arch of Riolan and is advanced into the inferior mesenteric artery until it reaches the aortic aneurysm sac. Angiography performed through the microcatheter demonstrates the presence of a type 2 endoleak sustained by the inferior mesenteric artery with outflow through a patent lumbar artery ( A ). Coil embolization of the inferior mesenteric artery is performed. Final angiography demonstrates interruption of the inflow of the leak ( B ).
Fig. 3
Fig. 3
Transcaval embolization of a type 2 endoleak. Through right venous femoral percutaneous access, a transcaval puncture of the aortic aneurysm sac is performed with the use of a TIPS (transjugular intrahepatic portosystemic shunt) needle. A hydrophilic guidewire is inserted through the needle and is used for introducing a 5-Fr catheter in the aneurysm sac. Angiography is performed through the catheter and confirms the presence of a type 2 endoleak sustained by several patent lumbar arteries ( A ). The leak is embolized by injecting cyanoacrylate in the aneurysm sac through the catheter. Final control shows the presence of radiopaque cyanoacrylate in the aneurysm sac right where the presence of type 2 endoleak was previously demonstrated ( B ).
Fig. 4
Fig. 4
Management of patients with type 2 endoleak and a > 1-cm abdominal aortic aneurysm (AAA) sac growth.
See this image and copyright information in PMC

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