Endovascular treatment of delayed type 1 and 3 endoleaks

Peter A. Naughton, Manuel Garcia-Toca, Heron E. Rodriguez, Aoife N. Keeling, Scott A. Resnick, Mark K. Eskandari*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Purpose: Endovascular aortic aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. Type I and III endoleaks require prompt, definitive repair or explantation. We review a single center experience of endovascular treatment of type I and III endoleaks. Materials and Methods: Retrospective review of 22 patients who underwent endovascular intervention for remediation of proximal or distal seal zone endoleaks. Results: Median age was 77 years. Median time interval from EVAR to reintervention was 4 years (range, 1 month-11 years). Sixteen patients (73%) had radiological evidence of endoleak and/or expanding sac size and 6 (27%) had contained rupture. Nine patients underwent a total of 12 endovascular reinterventions before this salvage procedure. Stent grafts used at the original procedure were: AneuRx (n = 10), Excluder (n = 7), Ancure (n = 3), Zenith (n = 1), and custom made (n = 1). Endoleaks treated were type Ia (n = 11), Ib (n = 12), and type III (n = 3). Interventions included: proximal cuff insertion with or without Palmaz stent insertion (n = 8), distal limb extension (n = 2), stent graft relining (n = 6), embolization of hypogastric artery and iliac limb extension (ILE) (n = 5), and aorto-uni-iliac stent graft (AUI) with femoral-femoral crossover (n = 1). One patient who had a rupture died of multiorgan failure. Two patients needed additional reinterventions for endoleaks. Median length of hospital stay was 1 day. Conclusion: Lifelong surveillance after EVAR is advocated because of the potential of delayed type I or III endoleaks, which mandate definitive treatment. Fortunately, most delayed type I and III endoleaks can be successfully corrected with endoluminal interventions rather than resorting to explantation of the endograft.

Original languageEnglish (US)
Pages (from-to)751-757
Number of pages7
JournalCardiovascular and Interventional Radiology
Volume34
Issue number4
DOIs
StatePublished - Aug 2011

Keywords

  • Abdominal aortic aneurysms (AAA)
  • Aorta
  • Arterial intervention
  • Endoleak
  • Endovascular aneurysm repair/endovascular aortic repair (EVAR)
  • Endovascular treatment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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