Outcome of Embolization of an Endoleak Type 2 After Placement of an Endoprosthesis for an Infrarenal Aorta Aneurysm.

Abstract

Objective: The aim of this study is to investigate the effect of transarterial (TA) and translumbar (TL) embolization of a type 2 endoleak (T2EL) after endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA) on the evolution and rupture of the aneurysmal sac.

Methods: A retrospective study was conducted including patients who underwent TA or TL embolization for a growing T2EL after EVAR from April 2001 to August 2022. Demographic data, used endograft, radiological data of the AAA and T2EL, embolization agents, techniques (TA or TL approach), and angiographical outcomes were collected from 48 patients with a total of 58 embolizations. The primary clinical outcome was rupture of the AAA. Secondary outcomes included T2EL recurrence, re-embolization of T2EL, aneurysm sac growth (≥5 mm), and mortality. Clinical success was defined as the absence of a 5 mm or greater increase in the aneurysm sac diameter.

Results: After primary T2EL embolizations, an increase in aneurysm sac was seen in 56.5% (n = 26), stability in 30.4% (n = 14), and regression in 13.0% (n = 6). Recurrence of T2EL had a significant impact on clinical success. No difference in sac size or evolution after the TA and TL embolization was noted. Rupture was found in 4 patients, but in only 1 patient it was caused by an isolated T2EL. The effect of increase in aneurysm sac size on overall survival was not statistically significant. Additionally, no associations were observed between the outcome and clinical factors including gender, obesity, chronic obstructive pulmonary disease, diabetes, hypertension, hypercholesterolemia, smoking, technique, used embolic agents, and time from endoleak onset to embolization.

Conclusion: In this retrospective study, 1 AAA rupture was attributable to an isolated T2EL out of 48 patients, with a clinical success rate of 43.5%.Clinical ImpactAlthough the impact of a type 2 endoleak (T2EL) on the outcome of an endovascular repaired abdominal aortic aneurysm is not yet clarified, in daily practice, the endovascular embolization is considered as a safe and effective option. Elimination or reduction of the volume of the endoleak can be obtained and can probably prevent aortic rupture, which is reassuring for the treating physician and the patient. The embolization of the T2EL reduces the need for extra imaging or hospitalizations, lowers the risk of complications and minimizes healthcare costs. This study contributes to the knowledge and treatment of T2EL, supporting clinicians in making better informed decisions, ultimately optimizing patient care. Moreover, this research found no outcome differences between the embolization techniques.