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Management of Endoleaks: A large, single-center experience
Benjamin Lind, MD1, Chad Jacobs, MD1, Ferral Hector, MD1, Peter Hunt, MD2, Goldin Marshall, MD1, Robert March, MD1, Walter McCarthy, MD1.
1Rush University Medical Center, Chicago, IL, USA, 2Cardiovascular Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.
Objective: As endovascular repair of abdominal aortic aneurysm has become commonplace, more has been learned about the nature of postoperative endoleak. Here we describe the results of a large series of cases and describe treatment options for complex endoleaks.
Methods: A prospectively-maintained database was searched for patients who underwent EVAR and subsequently developed endoleaks. Charts were reviewed to determine the nature and course of treatment.
Results: Between March, 2001 and December, 2009, a total of 111 patients (90 male, 21 female) were treated for AAA. Mean age was 71 years old. Patients were followed with contrast CT scans in most cases. A total of 32 patients with 36 endoleaks were identified. Nine Type I endoleaks were discovered; 22 Type II endoleaks were discovered. One each of Type III and Type IV endoleaks were discovered.
Six of the Type I endoleaks were type Ia; three of these were successfully treated with proximal cuff placement. One required open repair. Three of the Type I endoleaks were type Ib; all were successfully treated with internal iliac artery embolization and distal cuff placement.
Type II endoleaks stable in size were safely followed without intervention. All type II endoleaks of increasing size underwent intervention. Interventions included accessing sac via the Arc of Riolan and placement of hydrocoils; direct, translumbar sac puncture with coil placement; and open surgical ligation of lumbar arteries.
The Type III endoleak was treated successfully with an additional stent graft. The Type IV endoleak was relined.
There were no deaths related to endoleaks or their management in this series.
Conclusions: EVAR is now the most common method of treating abdominal aortic aneurysm. Endoleak is a common finding. Most are Type II and can be safely followed. When treatment is required, there are a number of treatment strategies available. Persistent enlarging Type II endoleaks may require advanced therapeutic strategies. With careful management, the morbidity and mortality of endoleaks can by minimized. The natural course of endoleaks and their management should be well understood by treating physicians.
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