title: Predictive factors for the development of type II endoleaks.
abstract: OBJECTIVE
  To define predictive factors for endoleak type II (EL-II) based on quantifiable factors in the imaging studies of patients undergoing endovascular aneurysm repair (EVAR).
  
  
  METHODS
  The data on 208 consecutive patients (137 men; mean age 75.2 years, range 62-84) who underwent EVAR between the years 2003 and 2008 were retrospectively reviewed. The abdominal aortic aneurysm (AAA) diameter ranged from 4.8 to 12.8 cm. Data were collected on the type of AAA; the type of stent-graft (aortomonoiliac versus bifurcated); the performance of hypogastric artery embolization; the presence, number, diameter, and patency of aortoiliac branches identified on the pre and post-EVAR imaging studies; and the presence and type of EL-II (transient vs. persistent) with the goal of identifying any imaging-based predictive factors for the development of EL-II.
  
  
  RESULTS
  Among the 208 cases, 11 patients had endoleaks other than type II and were excluded, leaving 195 patients for analysis. In all, 28 (13.4%) patients were diagnosed with EL-II. All had ≥4 patent lumbar arteries (mean diameter >2.3 mm). Ten patients with a transient EL-II had a mean of 4.3 patent lumbar arteries, which had diameters <2 mm (mean 1.5 mm). In the 18 patients with persistent EL-II, the mean diameter of the 4 lumbar arteries was 2.7 mm; at least 1 of the lumbar arteries was >2 mm. The presence of at least 4 patent lumbar arteries (p<0.001) and at least 1 patent hypogastric artery (p<0.001) were predictive factors for EL-II. At least 1 lumbar artery >2 mm in diameter was a positive predictive factor for the development of persistent EL-II (p<0.001).
  
  
  CONCLUSIONS
  Patent hypogastric and lumbar arteries are significantly associated with a higher risk of developing EL-II. Larger diameter lumbar arteries tend to be associated with persistent EL-IIs, while lumbar arteries <2 mm would more likely be seen with a transient EL-II. If substantiated in larger studies, these angiographic criteria may guide early treatment of EL-II to avoid aneurysm sac expansion and potential rupture.
authors.affiliation: Division of Vascular Surgery, Dr. Beda General Hospital, Campos, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Marchiori
authors.forename: Arno
authors.initials: A
authors.lastname: von Ristow
authors.forename: Marcelo
authors.initials: M
authors.lastname: Guimaraes
authors.forename: Claudio
authors.initials: C
authors.lastname: Schönholz
authors.forename: Renan
authors.initials: R
authors.lastname: Uflacker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D001938:Brazil; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000098:blood supply*; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013022:South Carolina; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency