Predictive factors, morphologic effects, and proposed treatment paradigm for type II endoleaks after repair of infrarenal abdominal aortic aneurysms.
OBJECTIVE
To evaluate the predictive factors and outcome of type II endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms with use of a Zenith endograft.


METHODS
Patients classified at high risk were enrolled in a prospective study and evaluated with serial cross-sectional imaging techniques. The effect of a type II endoleak on sac behavior and associated factors were analyzed. Type II endoleaks were categorized as absent, persistent, or transient, and the morphologic effects were determined. Logistic regression and classification tree were used to predict which patients may be at risk for persistent type II endoleaks.


RESULTS
A total of 273 patients were enrolled. Patients were excluded in the absence of a minimum of 6 months digital data or the presence of endoleak not classified as type II. Two hundred four patients met inclusion criteria, with a median follow-up period of 24 months (range, 6-60 months). Early type II endoleak was detected in 35 patients (17%), which resolved spontaneously in 17 cases. There were 18 patients with persistent endoleak, 17 patients with transient type II endoleak, and 169 patients with no endoleak. Aneurysm enlargement was detected in seven patients with persistent endoleak (39%), no patients with transient type II endoleak, and one patient with no endoleak. No variables were predictive of the development of persistent endoleak. The relative risk of aneurysmal growth was 77 with persistent endoleak. Successfully treated persistent endoleaks were not associated with any growth.


CONCLUSIONS
Persistent endoleaks are associated with sac growth. Transient type II endoleaks have a benign course and do not require treatment. Successful treatment of persistent endoleak ameliorates the risk of growth.
Department of Vascular Surgery, Cleveland Clinic Hospital Systems, Cleveland, Ohio 44195, USA.
Wataru
W
Higashiura
Roy K
RK
Greenberg
Ethan
E
Katz
Leslie
L
Geiger
Shona
S
Bathurst
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D012107:Research Design; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation