title: Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion.
abstract: OBJECTIVE
  To examine the outcomes following interventions for type II endoleaks in patients with aneurysm sac expansion after endovascular aneurysm repair (EVAR).
  
  
  METHODS
  A retrospective review was conducted of all patients who underwent treatment for type II endoleak from July 2001 to September 2010 in a single center. In this time period, 29 (4.7%) patients (22 men; mean age 78.6 years, range 54-87) were identified as having a type II endoleak and enlargement of the aneurysm sac, meeting the criterion for treatment. All patients had at least one attempted percutaneous intervention. Patients were followed both clinically and radiographically, with computed tomographic angiography every 3 to 12 months, over a follow-up period that ranged from 1 to 10 years (mean 3.5).
  
  
  RESULTS
  Forty-eight interventions were performed on the 29 patients. Of these, 15 (56%) patients underwent multiple (2-4) procedures. Of the 11 endoleaks with an isolated inferior mesenteric artery identified as the source, initial success for transarterial embolization at 2 years was 72%, with 2 of the failures having successful secondary interventions. For the 18 endoleaks with a lumbar source, the success of the initial intervention was 17% at 2 years; repeated embolization attempts produced a 40% secondary success rate. Seven (24%) patients had continued endoleak despite multiple treatment attempts; 3 ultimately required elective aortic graft explantation. There were no ruptures or deaths during the study period. In a comparison of type II endoleak patients who had stable aneurysm sacs and those who had persistent sac expansion, the only significant differences in preoperative anatomical characteristics were a lower prevalence of mural thrombus (p = 0.036) and longer right iliac arteries (p = 0.012) in the group with sac expansion. Independent predictors of type II endoleak were mural thrombus (p<0.001), patent lumbar arteries (p = 0.004), aneurysm length (p = 0.011), and iliac artery length (p = 0.004).
  
  
  CONCLUSIONS
  This study demonstrates that most patients require multiple reinterventions to treat type II endoleaks; specifically, lumbar artery embolization carries a low midterm success rate.
authors.affiliation: University of Michigan Hospital, Ann Arbor, Michigan, USA. kgallag@umich.edu
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Gallagher
authors.forename: Reid A
authors.initials: RA
authors.lastname: Ravin
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meltzer
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Khan
authors.forename: Asad
authors.initials: A
authors.lastname: Khan
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Coleman
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Graham
authors.forename: Francesco
authors.initials: F
authors.lastname: Aiello
authors.forename: Gautam
authors.initials: G
authors.lastname: Shrikhande
authors.forename: Peter H
authors.initials: PH
authors.lastname: Connolly
authors.forename: Rajeev
authors.initials: R
authors.lastname: Dayal
authors.forename: John K
authors.initials: JK
authors.lastname: Karwowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome