title: Type II endoleaks after endovascular repair of abdominal aortic aneurysms: fate of the aneurysm sac and neck changes during long-term follow-up.
abstract: OBJECTIVE
  To evaluate the frequency of type II endoleaks after endovascular aneurysm repair (EVAR) and to compare sac diameter and neck changes in patients with type II endoleak to endoleak-free patients with at least 3-year imaging follow-up.
  
  
  METHODS
  Among 407 consecutive EVAR patients, 109 patients (101 men; mean age 72.1 years, range 55-86) had at least 3-year computed tomography (CT) data and no type I or III endoleak. In this cohort, 49 patients presented with a type II endoleak at some time and 60 patients had no endoleak. Patients with type II endoleaks were further divided into subgroups based on the vessel origin and the perfusion status (persistent or transient). The course of the perfusion status of type II endoleaks and changes in the aneurysm sac diameters, neck diameters, and renal to stent-graft distances (RSD) were evaluated in the defined groups. Reintervention and death rates were also reported.
  
  
  RESULTS
  The mean follow-up was 68.1 ± 23.8 months. Compared to the no endoleak group, overall sac diameter increased significantly in the type II endoleak group (p = 0.007), but vessel origin did not have any influence. With regard to the perfusion status of type II endoleaks, aneurysm sac changes were significantly higher (p = 0.002) in the persistent endoleak group. During the study period, the increase in the proximal neck diameter was significantly higher in the no endoleak group compared to the type II endoleak group (p = 0.025). No significant difference was found in RSD changes between the defined groups. Reinterventions were performed in 20 (18.3%) patients (13 for type II endoleak); 2 (1.8%) patients without type II endoleak died of ruptured aneurysm.
  
  
  CONCLUSIONS
  Persistent type II endoleaks led to significant aneurysm sac enlargement, but without increased mortality or rupture rates.
authors.affiliation: Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria. richard.nolz@meduniwien.ac.at
authors.forename: Richard
authors.initials: R
authors.lastname: Nolz
authors.forename: Harald
authors.initials: H
authors.lastname: Teufelsbauer
authors.forename: Ulrika
authors.initials: U
authors.lastname: Asenbaum
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beitzke
authors.forename: Martin
authors.initials: M
authors.lastname: Funovics
authors.forename: Andreas
authors.initials: A
authors.lastname: Wibmer
authors.forename: Christina
authors.initials: C
authors.lastname: Plank
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Prusa
authors.forename: Johannes
authors.initials: J
authors.lastname: Lammer
authors.forename: Maria
authors.initials: M
authors.lastname: Schoder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D001027:Aortography / Q000379:methods; D001317:Austria; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D018572:Disease-Free Survival; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome