Endovascular abdominal aortic aneurysm repair (EVAR) is a safe and minimally invasive
alternative to open surgical repair for infra renal aortic aneuvrysm. EVAR requires
lifelong post-procedural surveillance. Endoleaks represent the main complication.
Type II endoleaks (EL2) are the most frequent and tend to be indolent. Most practitioners
do not treat in EL2 as long as they are associated with stable aneurysm diameter.
European guidelines recommend treatment in case of aneurysm growth. Several techniques
can be offered, such as transarterial embolization and translumbar embolization. This
study reports the experience and results of a single center for EL2 endovascular treatment.
The aim of this study was to determine more precisely the efficacity of embolization
for type 2 endoleaks treatment.
A single center cohort of patients treated for EL2 with endovascular technique between
1998 and 2018 was formed to perform a descriptive analysis. Preoperative sizing, risk
factors of endoleaks and intraoperative data were collected. Computed topography (CT)
scans were regularly performed after EVAR to detect endoleak recurrence. Clinical
recurrence was defined as the persistence of aneurysm sac growth and radiological
recurrence was defined as the occurrence of EL2 on a post-embolization CT scan. Data
related to reintervention, overall mortality and aneurysm related mortality were also
collected. Kaplan-Meier survival analyses were used to determine the rates of reoperation-free
survival and recurrence-free survival.
Six hundred seven patients underwent an endovascular treatment for abdominal aorta
aneurysm between 1998 and 2018. One hundred forty-five type 2 endoleaks occurred during
this period. Nineteen patients (median age 76 years), underwent endovascular treatment
for EL2, with immediate success on 15 patients (8 transarterial embolization, 8 direct
sac puncture and 3 combined procedures). During follow-up, 5 patients required a new
translumbar embolization and 6 required an open surgery for recurrence of the EL2.
Six patients died, 2 of them of causes related to the aneurysm. At 59,6 months median
follow-up, 53% of the patients presented a radiologic recurrence, with a sac growth
of more than 5 mm since last procedure in 4 patients (24%).
Long term clinical recurrence of type 2 endoleaks treated by endovascular procedures
appear to be frequent in our experience, leading to several deaths and requiring open