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Moosavi B, Kaitoukov Y, Khatchikian A, Bayne JP, Constantin A, Camlioglu E. Direct sac puncture versus transarterial embolization of type II endoleaks after endovascular abdominal aortic aneurysm repair: Comparison of outcomes. Vascular 2024; 32:499-506. [PMID: 36753720 PMCID: PMC11129519 DOI: 10.1177/17085381231156661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE Type 2 endoleak (T2EL) is the most common type of endoleak after endovascular abdominal aortic aneurysm repair (EVAR), and increases the risk of aneurysm sac rupture if it persists beyond 6 months. The purpose of this study is to compare the efficacy and safety of direct sac puncture versus transarterial embolization of T2ELs. METHODS Retrospective review of 42 consecutive T2EL embolization procedures, 19 by DSP and 23 by transarterial technique, between January 2015 and December 2020. Primary outcome was aneurysm sac stability and resolution of endoleak at follow-up imaging. Adverse events (AE) were classified based on the Society of Interventional Radiology (SIR) practice guidelines. RESULTS Technical success was 94.7% (18/19) in the DSP group and 86.9% (20/23) in the transarterial group (p = 0.32 (-0.77-0.25)). Treatment efficacy was evaluated in 16 patients in the DSP group and 18 patients in the transarterial group who had follow-up imaging ≥6 months after embolization. Mean imaging follow-up was 17.1 ± 11.2 (range, 6-41) months in the DSP group and 26.5 ± 15.4 (range, 6-48) months in the transarterial group (p = 0.06, -19.24-0.37). Treatment efficacy was 75% (12/16) in the DSP group and 33.3% (6/18) in the transarterial group (p = 0.02, 95% CI, 0.09-0.97). There was no procedure-related mortality. Moderate-severe AE occurred in 15.7% (3/19) in the DSP group and 8.7% (2/23) in the transarterial group (p = 0.44, -0.12-0.26). CONCLUSION In this study, DSP embolization of T2EL was equally safe and more effective than transarterial embolization in achieving aneurysm sac stability and resolution of endoleak.
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Affiliation(s)
- Bardia Moosavi
- Department of Radiology, McGill University, Montreal, QC, Canada
| | - Youri Kaitoukov
- Department of Radiology, McGill University, Montreal, QC, Canada
| | - Aline Khatchikian
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - Jason P Bayne
- Department of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada
| | | | - Errol Camlioglu
- Department of Radiology, Jewish General Hospital, QC, Canada
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Li X, Guo P, Wang L, Li Q, Zhang L, Qiu J, He H, Li J, Yang C, Shu C. Treatment strategies for endoleak after endovascular repair of the abdominal aortic aneurysm: A single center retrospective study. Asian J Surg 2023; 46:3748-3754. [PMID: 36732180 DOI: 10.1016/j.asjsur.2023.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) is the most frequently used treatment for aneurysm in abdominal aorta. The endoleak after EVAR causes the aneurysm sac to remain enlarged and risk for rupture. AIMS The purpose of the study was to assess the efficacy of strategies and techniques for endoleak treatment. METHODS This study was a single center retrospective study of 30 patients who had kinds of endoleak. The 30 patients were from a cohort of 597 patients who received EVAR from the Secondary Xiangya Hospital, Central South University between Jan 2014 to Dec 2021, what is follow-up well and diagnosed as endoleak. Data included basic clinical information, aspects of the endoleak treatment techniques, and follow-up findings. RESULTS The 30 patients with endoleak were diagnosed by computed tomography angiography or digital subtraction angiography. Age is 69 ± 7.9 yrs. 26 patients are male with only 4 female patients. Immediate endoleak after EVAR is 46.7%and delayed endoleak is 53.3%. The classification of endoleak is type Ⅰ:76.6%; type Ⅱ 26.7%; type Ⅲ:6.7%; type Ⅳ:6.7%; type Ⅴ:13.3%. Different treatment of endoleak includes: screening, endovascular re-intervention and open surgery. There are 3 patients (10.0%) underwent emergency EVAR due to their rupture condition of aneurysm. All the endoleak patients' CTA image characteristics has been reviewed. The follow-up rate is 93.3%. There are 6 patients (21.4%) died during follow-up. No aneurysm sac rupture death has been recorded. CONCLUSIONS Endoleak after EVAR is the most frequent complication that directly affects survival and re-intervention rates. Our findings suggested that different treatment strategies based on the individual patient's situation is important for their endoleak treating result.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Pengcheng Guo
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Lei Zhang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Jian Qiu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Chenzi Yang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China; National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Sirignano P, Mangialardi N, Nespola M, Aloisi F, Orrico M, Ronchey S, Del Porto F, Taurino M. Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers. J Pers Med 2022; 12:jpm12030339. [PMID: 35330339 PMCID: PMC8954032 DOI: 10.3390/jpm12030339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The aim of the present study is to report the outcome of patients presenting an isolated type II endoleak (TIIEL) requiring reintervention and to identify clinical and anatomical characteristics potentially implicated in refractory TIIEL occurrence and fate. Materials and Methods: A multicenter retrospective study on TIIEL requiring reintervention was conducted between January 2003 and December 2020. Demographic and clinical characteristics, procedural technical aspects, reinterventions, and outcomes were recorded. TIIEL determining sac expansion greater than 10 mm underwent a further endovascular procedure aiming to exclude aneurismal sac. Redo endovascular procedures were performed via endoleak nidus direct embolization and/or aortic side branches occlusion. TIIELs responsible for persisting aneurysmal sac perfusion 6 months after redo endovascular procedures were classified as “refractory” and submitted to open conversion. Results: A total of 102 TIIEL requiring reintervention were included in the final analysis. Eighty-eight (86.27%) patients were male, the mean age was 77.32 ± 8.08 years, and in 72.55% of cases the American Society of Anaesthesiologists (ASA) class was ≥3. The mean aortic diameter was 64.7 ± 14.02 mm, half of treated patients had a patent inferior mesenteric artery (IMA), and 44.11% ≥ 3 couples of patent lumbar arteries (LA). In 49 cases (48.03%) standard endovascular aneurysm repair (EVAR) procedure was completed without adjunctive maneuvers. All enrolled patients were initially submitted to a further endovascular procedure once TIIEL requiring reintervention was diagnosed; 57 patients underwent LAs or IMA embolization (55.87%), 42 transarterial aneurismal sac embolization (41.17%), and three (2.96%) laparoscopic ostial ligations of the inferior mesenteric artery. During a mean follow-up of 15.22 ± 7.57 months (7−48), a redo endovascular approach was able to ensure complete sac exclusion in 52 cases, while 50 patients presented a still evident refractory TIIEL and therefore a surgical conversion or semiconversion was conducted. At the univariate analysis refractory TIIEL patients were significantly different from those who did not develop the complication in terms of preoperative clinical, morphological characteristics, and initial EVAR procedures: coronary artery disease occurrence (p = 0.005, OR: 3.18, CI95%: 1.3−7.2); preoperative abdominal aortic aneurysm (AAA) sac diameter (p = 0.0055); IMA patency (p = 0.016, OR: 2.64, CI95%: 1.18−5.90); three or more patent LAs; isolated standard EVAR without adjunctive procedures (p > 0.0001; OR: 9.48, CI95%: 3.84−23.4). Conclusions: Our experience seems to demonstrate that it is reasonable to try to preoperatively identify those patients who will develop a refractory TIIEL after EVAR and those with a TIIEL requiring reintervention for whom a simple endovascular redo will not be enough, needing surgical conversion.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Sant’Andrea Hospital, Department of Surgery Paride Stefanini, Sapienza University of Rome, 00189 Rome, Italy
- Correspondence: ; Tel.: +39-338-214-9813
| | - Nicola Mangialardi
- Department of Vascular Surgery, Ospedale San Camillo-Forlanini, 00152 Rome, Italy; (N.M.); (M.O.); (S.R.)
| | - Martina Nespola
- Vascular and Endovascular Surgery Unit, Sant’Andrea Hospital, Department of Molecular and Clinical Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.N.); (F.A.); (M.T.)
| | - Francesco Aloisi
- Vascular and Endovascular Surgery Unit, Sant’Andrea Hospital, Department of Molecular and Clinical Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.N.); (F.A.); (M.T.)
| | - Matteo Orrico
- Department of Vascular Surgery, Ospedale San Camillo-Forlanini, 00152 Rome, Italy; (N.M.); (M.O.); (S.R.)
| | - Sonia Ronchey
- Department of Vascular Surgery, Ospedale San Camillo-Forlanini, 00152 Rome, Italy; (N.M.); (M.O.); (S.R.)
| | - Flavia Del Porto
- Internal Medicine Unit, Sant’Andrea Hospital, Department of Molecular and Clinical Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Maurizio Taurino
- Vascular and Endovascular Surgery Unit, Sant’Andrea Hospital, Department of Molecular and Clinical Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.N.); (F.A.); (M.T.)
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Kalmykov EL, Suchkov IA, Kalinin RE, Damrau R. [Endoleaks in endovacular treatment of infrareneral abdominal aortic aneurysm (part I)]. Khirurgiia (Mosk) 2022:77-84. [PMID: 35775848 DOI: 10.17116/hirurgia202207177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We analyzed the PubMed, Scopus databases and the eLIBRARY electronic library regarding appropriate literature data. In the first part, modern classifications of endoleaks type 1 and 2 after stenting of infrarenal aortic aneurysm are considered. We described causes, risk factors and effectiveness of various treatment options.
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Affiliation(s)
| | - I A Suchkov
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - R E Kalinin
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - R Damrau
- St. Katharinen Hospital, Frechen, Germany
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