Intraoperative endoleak during EVAR: frequency, nature, and significance.
OBJECTIVE
Endoleaks are critical complications of endovascular abdominal aortic aneurysm repair (EVAR). This study sought to determine the frequency and nature of intraoperative endoleaks and their impact on postoperative endoleak-related events.


METHODS
A retrospective chart review was performed of all patients who underwent EVAR at our institution. The impact of intraoperative endoleaks on postoperative endoleak rates and endoleak-related reintervention rates were assessed.


RESULTS
From December 18, 1996, to May 21, 2003, 241 patients underwent EVAR. An endoleak was observed during 126 (52.3%) procedures. Type I endoleaks were observed in 63 (26.1%) cases: 35 proximal and 31 distal endoleaks (3 cases at both attachments). Angioplasty, additional cuff placement, or stenting corrected 59 (89.4%) of these endoleaks. A total of 71 type II intraoperative endoleaks (29.5%) and 8 type IV endoleaks (3.3%) were observed without any attempted corrective maneuvers. Ten type III endoleaks (4.2%) occurred but all resolved with angioplasty or additional cuff placement. In all, 86 (35.7%) endoleaks persisted on completion angiogram. Patients with a type I or type II intraoperative endoleak were more likely to have an endoleak at 1.5 years (31.4% vs. 21.6%, P=.018). Reinterventions were required more often after an intraoperative type I endoleak (10% vs. 4%, P=.003). Patients with intraoperative endoleaks demonstrated a trend toward less postoperative aneurysm diameter reduction at 2 years (43.8% vs. 74.5%, P=.104).


CONCLUSIONS
The presence of a type I or a type II endoleak during EVAR significantly increases the likelihood of a postoperative endoleak and should prompt a high degree of suspicion during follow-up.
Eastern Virginia Medical School, and Division of Vascular Surgery, Sentara Heart Hospital, Norfolk, Virginia, USA.
Sergio M
SM
Sampaio
Susanna H
SH
Shin
Jean M
JM
Panneton
James C
JC
Andrews
Thomas C
TC
Bower
Kenneth J
KJ
Cherry
Audra A
AA
Duncan
Manju
M
Kalra
Peter
P
Gloviczki
D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D019544:Equipment Failure Analysis; D006801:Humans; D007432:Intraoperative Period; D053208:Kaplan-Meier Estimate; D011184:Postoperative Period; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex