title: Evaluation and treatment of suspected type II endoleaks in patients with enlarging abdominal aortic aneurysms.
abstract: OBJECTIVE
  To evaluate angiographic diagnosis and embolotherapy of patients with enlarging abdominal aortic aneurysms and computed tomographic (CT) diagnosis of type II endoleak.
  
  
  METHODS
  A retrospective review was performed of all patients referred to a single vascular and interventional radiology section from January 1, 2003, to June 1, 2011, with a diagnosis of enlarging aneurysm and type II endoleak. Twenty-five patients underwent 40 procedures between 12 and 82 months after endograft insertion (mean, 48 mo) for diagnosis and/or treatment of endoleaks.
  
  
  RESULTS
  Type II endoleaks were treated with cyanoacrylate, coils, and ethylene vinyl alcohol copolymer in 16 patients. Technical success rate was 88% (14 of 16 patients) and clinical success rate was 100% (16 of 16 patients). Aneurysm growth was arrested in all cases over a mean follow-up of 27.5 months (range, 6-88 mo). Endoleaks in nine patients were misclassified on CT; two had type I endoleaks and seven had type III endoleaks. Four of the nine patients (two type I endoleaks and two type III endoleaks) were correctly classified after initial angiography. The other five type III endoleaks were correctly classified on CT after coil embolization of the inferior mesenteric artery. Direct embolization was performed via sac puncture with ethylene vinyl alcohol copolymer in two of the latter five patients and eliminated endoleaks in both.
  
  
  CONCLUSIONS
  Aneurysm growth caused by type II endoleaks was arrested by embolization. CT misclassification occurred relatively commonly; type III endoleaks purported to be type II endoleaks were found in 28% of patients (seven of 25).
authors.affiliation: Section of Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, 5840 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA. bfunaki@radiology.bsd.uchicago.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Funaki
authors.forename: Nour
authors.initials: N
authors.lastname: Birouti
authors.forename: Steven M
authors.initials: SM
authors.lastname: Zangan
authors.forename: Thuong G
authors.initials: TG
authors.lastname: Van Ha
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Lorenz
authors.forename: Rakesh
authors.initials: R
authors.lastname: Navuluri
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Skelly
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Leef
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D057867:Endoleak / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics