Outcome and clinical significance of delayed endoleaks after endovascular aneurysm repair

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• 作者：Wei Zhou ; MD^a ; ^b ; ^{weizhou@stanford.edu" class="auth_mail} ; Eddie Blay Jr. ; BA^c ; Vinit Varu ; MD^a ; Syed Ali ; BS^d ; Michelle Qiushuang Jin ; BA^e ; Lisa Sun ; MS^f ; Jin Hyun Joh ; MD ; PhD^g
• 刊名：Journal of Vascular Surgery
• 出版年：April, 2014
• 年：2014
• 卷：59
• 期：4
• 页码：915-920
• 全文大小：301 K

文摘

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Objective

Endovascular aneurysm repair (EVAR) is considered the standard therapy for most patients with abdominal aortic aneurysm (AAA). Endoleak is a well-known EVAR-related complication that requires long-term follow-up. However, patient follow-up is often challenging outside clinical trials. We sought to evaluate the incidence and the effect of delayed endoleaks in a Veterans Administration (VA) health care system where long-term follow-up is ensured.

Methods

We retrospectively evaluated 213 consecutive patients who underwent EVAR at a referral Veterans Administration medical center. Age, aneurysm size, patency of lumbar and inferior mesenteric arteries, and follow-up evaluations were recorded. Type of endoleak, date of detection, and intervention were also documented. Patients who had聽<1聽year of follow-up were excluded. The 蠂² test, Student t-test, Mann-Whitney test, and Spearman correlation were used for data analysis.

Results

The analysis included 183 patients with a mean follow-up of 53聽months (range, 12-141聽months); of these, 48 patients (26%) had endoleaks, and 31 (17%) had aneurysm progression. The mean diagnosis time for nontype II (n聽= 14) endoleaks was 45聽months (range, 3-127聽months), and 71% were diagnosed >1聽year after EVAR. All except one nontype II endoleak received prompt secondary interventions, and the one without intervention presented with aneurysm rupture. An isolated type II endoleak was detected in 34 patients at an average of 14.4聽months (range, 0-76聽months) after EVAR, 41% of which were detected >1聽year after EVAR. Patients without a documented endoleak had a significant decrease in aneurysm size at the latest computed tomography evaluation compared to the preoperative size (4.8 vs 5.7聽cm; P聽< .001), whereas those with isolated type II endoleak had an increase at the latest computed tomography follow-up compared to preoperative size (5.8 vs 5.7聽cm). Importantly, 59% of the patients with a type II endoleak had significant AAA enlargement (0.8聽cm), and delayed type II endoleak was significantly associated with sac enlargement compared to type II endoleaks detected early. No significant correlation was seen between the diameter of inferior mesenteric artery or lumbar to AAA enlargement among the patients with a type II endoleak. Secondary interventions in 12 patients with isolated type II endoleak resulted in overall aneurysm stabilization or regression.

Conclusions

This long-term outcome study demonstrated that delayed endoleaks appearing >1聽year after EVAR contributed to most of the overall endoleaks and were significantly associated with aneurysm sac growth. This study underscores that type II endoleak is not benign and that vigilant lifelong surveillance after EVAR is critical.