Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques.
OBJECTIVE
The exact significance of collateral endoleaks is unknown and a topic of great debate. Because of this uncertainty, some physicians choose to watch and wait while others aggressively treat these leaks. The purpose of this investigation was the evaluation of the efficacy of the two techniques used in the treatment of collateral endoleaks that occur after endovascular aneurysm repair.


METHODS
Patients with 33 angiographically proven type 2 endoleaks underwent treatment with either transarterial inferior mesenteric artery embolization (n = 20) or direct translumbar embolization (n = 13) during an 18-month period. Embolization success was defined as resolution of endoleak on all subsequent computed tomography angiogram results. The likelihood of embolization failure between the two treatments was expressed as a risk ratio and was compared with Fisher exact test.


RESULTS
Sixteen of 20 transarterial inferior mesenteric artery embolizations (80%) failed with recanalization of the original endoleak cavity over time. A single failure (8%) in the direct translumbar embolization group occurred in a patient in whom a new attachment site leak developed. The remaining 12 translumbar endoleak embolizations (92%) were successful and durable, with a median follow-up period of 254 days. The patients who underwent transarterial inferior mesenteric artery embolization were significantly more likely to have persistent endoleak than were the patients who underwent treatment with direct translumbar embolization (risk ratio, 4.6; 95% confidence interval, 1.9 to 11.2; P =.0001).


CONCLUSIONS
The transarterial embolization of inferior mesenteric arteries for the repair of type 2 endoleaks is ineffective and should not be performed. Direct translumbar embolization of the endoleak is effective in the elimination of type 2 leaks and should be the therapy of choice when aggressive endoleak management is indicated.
Baum
Richard A
RA
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA. rbaum@partners.org
Carpenter
Jeffrey P
JP
Golden
Michael A
MA
Velazquez
Omaida C
OC
Clark
Timothy W I
TW
Stavropoulos
S William
SW
Cope
Constantine
C
Fairman
Ronald M
RM
Stavropoulous
S Willliam
SW
D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic; D004724:Endoscopy / Q000009:adverse effects*; D006801:Humans; D008161:Lumbosacral Region / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*; D016017:Odds Ratio; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014656:Vascular Surgical Procedures / Q000009:adverse effects*