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Objectives: Debate regarding both the clinical implication and the resulting management of type II endoleaks is ongoing. We present the trends in treatment over a 7.5-year period at a tertiary referral center hypothesizing that detailed imaging is critical and that type II endoleaks causing aneurysm sac enlargement can largely be managed endovascularly.
Methods: This is a retrospective review of all patients hospitalized and referred for directed treatment of type II endoleaks between January 2008-May 2015. All procedures (diagnostic and therapeutic) as well as hospital courses and any follow up were captured and analyzed.
Results: Two-hundred and fifty-two type II endoleaks were evaluated with a 95% treatment rate. The average age at endoleak presentation was 77. The average time from index EVAR to endoleak treatment was 3.7 years with an average follow up after endoleak treatment of 1.5 years. Significant associations were found between year of presentation for treatment and original endograft device requiring treatment (P < .001). Thirty percent of the cohort had an AneuRx stent graft requiring treatment prior to 2013. There was a statistically significant correlation between year treated and pre-operative imaging obtained (P = .0084), with a trend toward computed tomographic angiography. Eighty-eight percent of patients were treated for expanding aneurysm sac, with a significant association found between year of treatment and diagnosis of expanding aneurysm (P = .0005). Seventy-seven percent of patients were treated via a transarterial, percutaneous femoral approach, 15% required a translumbar procedure, and the remaining 8% had open procedures. The source of the endoleak did significantly affect the choice of access vessel (P = .0001). Evolution of the treatment strategy was seen with Onyx being the more common agent used later in our experience (P< .0001). There was also significant movement toward same day discharge with an overall rate of 51% for the cohort (P = .0358).
Conclusions: Type II endoleaks continue to be a concern to the practicing endovascular surgeon. Based on our findings, we believe they deserve careful monitoring with utilization of CTA for diagnosis and follow-up. If associated with aneurysm sac enlargement, treatment is warranted and a transarterial, percutaneous approach is effective in the majority of cases with rare need for open operative repair.