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Type 2 Endoleak Following EVAR is Associated with Aneurysm Expansion Without a Negative Impact on Survival
John B. Luke, III, MD, Zdenek Novak, MD, Mark A. Patterson, MD, Marc A. Passman, MD, Thomas C. Matthews, MD, Benjamin J. Pearce, MD, William D. Jordan, Jr., MD. University of Alabama at Birmingham, Birmingham, AL, USA.
OBJECTIVES: Abdominal aortic aneurysm (AAA) sac behavior following endovascular aneurysm repair (EVAR) is a dynamic process that mandates long term surveillance. This study evaluates predictors for aneurysm sac growth and post EVAR survival to define the impact of endoleak on overall patient survival. METHODS: All EVARs performed in a single institution with at least 6 month imaging follow up between 1999-2013 were identified from a prospectively maintained registry. Review of medical records and imaging was performed. Patient groups were stratified by endoleak type. Cox regression, Chi squared test, and Kaplan-Meier analysis was performed comparing medical co-morbidities to sac growth and overall patient survival. RESULTS: Of 800 patients, 296 (37.0%) exhibited endoleak during at least one encounter during their post EVAR surveillance. More specifically, 219 patients (27.3%) exhibited type 2 endoleak (T2EL). Of those with T2EL, 27(3.3%) showed evidence of sac growth > 5mm. Additionally, 21(77.8%) patients with T2EL required at least one re-intervention due to sac expansion. Patients with T2EL were found to demonstrate similar sac behavior when compared to those without endoleak with 5 year surveillance. As surveillance approached 10 years, those with T2EL revealed a roughly 19% greater incidence for significant sac growth when matched to those without endoleak. Hypertension and endoleak were significantly associated with sac growth >5mm (p=0.013, OR 1.9 and p<0.001, OR 4.6 respectively). Presence of T2EL during surveillance was not associated with worsened overall survival (Figure 1). CONCLUSIONS: Post EVAR endoleak and hypertension significantly affect aneurysm sac behavior. Although associated with AAA sac growth, T2El does not confer a negative impact on post EVAR long term patient survival.
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