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Outcome of Secondary Aortic Endovascular Interventions for Type Ia Endoleaks following EVAR
Areck A. Ucuzian, MD, PhD, Eric Hager, MD, Luke Marone, MD, Rabih Chaer, MD, Steven Leers, MD, Michel Makaroun, MD, Michael J. Singh, MD.
UPMC, Pittsburgh, PA, USA.

Outcome of Secondary Aortic Endovascular Interventions for Type Ia Endoleaks following EVAR
Objective:
The snorkel technique for endovascular aneurysm (sn-EVAR) repair has been described in the literature as a safe and viable alternative for treating juxtarenal aortic aneurysms. The purpose of this study was to determine the outcome of secondary aortic interventions (renal artery snorkel technique combined with proximal aortic cuff extension) for Type Ia endoleaks following EVAR.
Methods:
A retrospective chart review from January 2012 to April 2014 identified patients that underwent secondary aortic interventions for Type Ia endoleaks. Demographics, endoleak characteristics, surgical details and outcomes were collected. Patients with radiographically detectable Type Ia endoleaks (CT angio or completion aortography at the time of EVAR) were included.
Results:
A total of 8 patients underwent secondary aortic interventions for type Ia endoleaks. Five patients underwent single renal artery snorkel combined with aortic cuff and 3 patients underwent bilateral renal artery snorkels combined with aortic cuff. There were no identifiable endoleaks at the completion of the secondary aortic intervention. The mean follow-up was 6.5 months (1.6-9.5 months). One of eight patients failed to undergo post-operative imaging. Of the remaining 7 patients, 2 developed recurrent Type Ia endoleaks based on surveillance imaging (29%, n = 7). Both endoleaks were identified by 6 months. One of 2 recurrent endoleaks had an unremarkable 1 month post- operative CTA. Neither patient underwent re-intervention for the recurrent endoleak. Peri-operative complications included a peri-nephric hematoma and brachial artery pseudoaneurysm. At 1 month, there was no significant change in renal function compared to baseline (p=.11). The 30-day and 6-month mortalities were 0% and 38%. Two patients died from causes unrelated to the procedure and 1 expired from unknown causes.
Conclusion:
Secondary aortic interventions for proximal Type Ia endoleaks following EVAR are safe and provide satisfactory technical success. However, the absence of a Type Ia endoleak at the completion of the re-intervention does not confirm mid-term success. The high frequency of recurrent Type Ia endoleaks suggest that caution be exercised in utilization of this technique and a more frequent surveillance imaging regimen may be necessary.