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Outcome and Clinical Significance of Delayed Endoleaks After Endovascular Aneurysm Repair
Study Questions:
What is the incidence and the effect of delayed endoleaks in a Veterans Administration (VA) health care system where long-term follow-up is ensured?
Methods:
The investigators retrospectively evaluated 213 consecutive patients who underwent endovascular aneurysm repair (EVAR) at a referral VA medical center. Age, aneurysm size, patency of lumbar and inferior mesenteric arteries, and follow-up evaluations were recorded. Type of endoleak, date of detection, and intervention were also documented. Patients who had <1 year of follow-up were excluded. The χ2 test, Student t-test, Mann-Whitney test, and Spearman correlation were used for data analysis.
Results:
The analysis included 183 patients with a mean follow-up of 53 months (range, 12-141 months); of these, 48 patients (26%) had endoleaks, and 31 (17%) had aneurysm progression. The mean diagnosis time for nontype II (n = 14) endoleaks was 45 months (range, 3-127 months), and 71% were diagnosed >1 year after EVAR. All except one nontype II endoleak received prompt secondary interventions, and the one without intervention presented with aneurysm rupture. An isolated type II endoleak was detected in 34 patients at an average of 14.4 months (range, 0-76 months) after EVAR, 41% of which were detected >1 year after EVAR. Patients without a documented endoleak had a significant decrease in aneurysm size at the latest computed tomography evaluation compared to the preoperative size (4.8 vs. 5.7 cm; p < 0.001), whereas those with isolated type II endoleak had an increase at the latest computed tomography follow-up compared to preoperative size (5.8 vs. 5.7 cm). Importantly, 59% of the patients with a type II endoleak had significant abdominal aortic aneurysm (AAA) enlargement (0.8 cm), and delayed type II endoleak was significantly associated with sac enlargement compared to type II endoleaks detected early. No significant correlation was seen between the diameter of inferior mesenteric artery or lumbar to AAA enlargement among the patients with a type II endoleak. Secondary interventions in 12 patients with isolated type II endoleak resulted in overall aneurysm stabilization or regression.
Conclusions:
The authors concluded that delayed endoleaks appearing >1 year after EVAR contributed to most of the overall endoleaks, and were significantly associated with aneurysm sac growth.
Perspective:
This study reports that delayed endoleaks appearing >1 year after EVAR contributed to most of the overall endoleaks, and were significantly associated with aneurysm sac growth. Furthermore, unlike early type II endoleaks, delayed type II endoleaks were uniquely associated with aneurysm sac enlargement that warranted secondary interventions. This study underscores the necessity of vigilant long-term surveillance after EVAR.
Keywords: Mesenteric Artery, Inferior, Endoleak, Tomography, X-Ray Computed, United States Department of Veterans Affairs, Aortic Aneurysm, Abdominal
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