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Impact Of Type II Endoleak On Early And Mid-term Outcomes Following Endovascular Repair Of Ruptured Abdominal Aortic Aneurysm
Mohamad Chahrour, Salim Habib, Steven Van Meeteren, Shriya Kane, Crystal Rodriguez, Adeola Odugbesi, Rachael Nicholson, Maen Aboul Hosn.
University of Iowa, Iowa City, IA, USA.
OBJECTIVES: The survival benefit of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) in real-world practice continues to be evaluated. Management of type II endoleak after EVAR remains controversial, particularly in the setting of rupture. We aimed to compare early outcomes and mid-term survival in patients with and without type II endoleak following EVAR for rAAA.
METHODS: A retrospective review was conducted of all patients undergoing EVAR for rAAA between 2015 and 2025 at a single tertiary center. Patients with prior open or endovascular repair or active infection were excluded. Baseline demographics, comorbidities, and clinical outcomes were collected. Patients were stratified into two groups: (1) those without type II endoleak and (2) those with type II endoleak, as determined by completion angiography and follow-up computed tomography angiography (CTA). Kaplan-Meier survival analysis was performed to compare short- and mid-term survival between groups.
RESULTS: A total of 42 patients were included, of which 24 (57%) had an endoleak. The mean age was 75 years (range 65-86), and the majority were male (93%) with prevalent cardiovascular risk factors including hypertension (91%) and smoking history (95%). Baseline characteristics were comparable between the two groups. There was no significant difference in short term outcomes including in-hospital mortality (11.1% vs 8.3%, p-value=0.76) and discharge to home (44.4% vs 70.8%, p-value=0.09) between the two groups. On follow up CTA, 55% of endoleaks spontaneously resolved. Overall re-intervention was similarly comparable between the two groups (31.3% vs 21.7%, p-value=0.50). Kaplan-Meier survival analysis (figure 1) demonstrated similar survival rates, with 1 year survival at 83.3% vs 75.0% (log-rank p-value=0.75).
CONCLUSIONS: In this single-center experience, the presence of type II endoleak after EVAR for rAAA was not associated with worse early outcomes or decreased mid-term survival. More than half of type II endoleaks resolved spontaneously, and reintervention rates were comparable. These findings suggest that conservative management of type II endoleaks in the rAAA setting may be reasonable. Larger multicenter studies with longer follow-up are warranted to confirm these results.
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