Outcomes of Aneurysmal Rupture Secondary to Endoleaks- A Single Institution Experience
natasha hansraj, MBBS, Samantha Cox, MD, Shahab Toursavadkohi, MD, Rishi Kundi, MD, Megan Brenner, MD,MS, Melanie Hoehn, MD.
University of Maryland Medical Center, Baltimore, MD, USA.
OBJECTIVES: Endoleaks are rarely identified after open repair, with risk extending to 10-30.5% after EVAR. Persistent endoleak is associated with aneurysm sac pressurization and subsequent aneurysm rupture. Studies have associated type 1 an 3 endoleaks with rupture, while Saqib et al demonstrated a 0.5-2.4% chance of aneurysm rupture with type 2 endoleak . Our study aims to identify risk factors for endoleak related aneurysm rupture, as well as management strategy, outcomes and prognosis. METHODS: A retrospective chart review of endoleak ruptures were conducted from 1/2009 - 7/2009 at a tertiary referral center.RESULTS: Aneurysm rupture secondary to endoleak was identified in 18 patients. Average age 78 years(± 10 years) with average shock index of 0.8 (± 0.3). All patients had previous endovascular repair (n=18). Average time from initial repair was 5 years (± 4 years) with 27% of patients requiring intervention prior to presentation with rupture. Upon presentation with rupture, average aneurysm sac size was 8.3 cm (± 1.6 cm). Type 1 endoleak was the most common etiology of rupture (83%), along with type 2 (n=1) and type 3 (n=3). The mean length of hospital stay was 21 days, with 15 ICU days, and seven ventilator days. Eighty-nine percent of patients underwent endovascular repair at the time of rupture. Seventy-five percent (n = 12) of these patients had follow-up imaging for surveillance of the endovascular intervention post rupture. Initial technical success was confirmed by in hospital computed tomography scan in 80% (n=8) of the patients. Overall endoleak rate post endovascular intervention for rupture was 58.3% (7/12). All subsequent endoleaks were identified within one year of rupture with mean time to diagnosis of 79 days (range 4 - 312 days). Five of these patients had a successful endovascular re-intervention, one following repeat rupture. Mean time to follow up was 14 months (range 0.8- 48 months). In hospital mortality was 22%, and overall mortality 4-year 39%. CONCLUSIONS: Aneurysm rupture associated with endoleak has a significant in hospital mortality of 22%. Endovascular repair in this clinical scenario has a very high early endoleak rate with grater then 50% needing repeat intervention post aneurysm rupture. Given the potential consequence of endoleak in a previously ruptured sac, early and aggressive follow up is warranted.
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