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Type I Endoleak at Completion of Endovascular Abdominal Aneurysm Repair is Associated with Increased Perioperative Mortality
Tze-Woei Tan, MD1, Mohammad Eslami, MD2, Wayne W. Zhang, MD1, Denis Rybin2, Doros Gheorghe2, Alik Farber, MD2.
1Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA, 2Boston University Medical Center, Boston, MA, USA.

Background:
Type I endoleak (TIE) during endovascular abdominal aortic aneurysm repair (EVAR) is usually identified and treated intraoperatively. We evaluated the outcomes of patients who, despite possible treatment, had TIE at completion of EVAR.
Methods:
We examined consecutive EVAR within the Vascular Study Group of New England database (2003-2012) and compared the outcomes of patients who had TIE at completion with those who did not. Ruptured abdominal aortic aneurysms were excluded. Outcomes included perioperative death, cardiac complication, reoperation, and one-year mortality. Multivariable logistic regression was used to determine factors associated with perioperative mortality, as well as factors associated with TIE.
Results:
Among the 2,402 EVARs in the study cohort, 93% (2235) were performed electively; 7% had ( 167) symptomatic AAA. Eighty patients (3.3%) had TIE at completion of surgery; these patients were older, more likely to be female, have a larger endograft main body diameter and have unplanned graft extension (Table). TIE was associated with increased postoperative mortality(5% vs. 0.6%, p=.002) and cardiac dysrhythmia (8.8% vs. 3.2%, p=.02). Four patients underwent intraoperative conversion to open repair and none died before hospital discharge. In multivariable analysis, TIE was associated with increased perioperative mortality (Odds ratio (OR) 4.6, 95%Confidence Interval (CI) 1.3-16.7, p=.02). Other factors associated with perioperative death included female gender (OR 4.6, 95% CI 1.7-12.8, p=.003) and cardiac dysrhythmia (OR 17.5, 95% CI 6.0-50.6, p30mm (OR 2.5,95% CI 1.6-4.4, p<.001) and unplanned graft extension(OR 4.2,95% CI 2.5-7.3, p<.001).
Conclusions:
Type I endoleak at EVAR completion occurs in up to 3% of patients, and is associated with increasing age, female gender, larger endograft diameter and unplanned graft extension; TIE is associated with increased risk of perioperative mortality. Further study is needed to further define and improve perioperative outcomes of these at-risk patients.
Characteristics/ OutcomesOverall
(N=2402)
Type I Endoleak
(N=80)
None
(N=2322)
P Value
Age, mean ± SD73.8±8.477.9±8.473.6±8.5<.001
Female gender20.4%33.8%20.0%.004
Maximum diameter, mean ± SD57.7±22.661.4±11.957.6±22.9.14
Graft body diameter, mean ± SD27.2±3.928.8±3.927.2±3.6<.001
Unplanned graft extension10.4%32.1%9.6%<.001
Hospital Death0.7%5.0%0.6%.002
Dysrhythmia3.4%8.8%3.2%.018
Reoperation2.0%5.0%1.9%.08
One-year mortality5.7%8.8%5.6%.22


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