title: Clinical significance of type II endoleaks after thoracic endovascular aortic repair.
abstract: BACKGROUND
  To evaluate the clinical significance of type II endoleaks (ELII) after thoracic endovascular aortic repair (TEVAR).
  
  
  METHODS
  From January 1997 to June 2012, a total of 344 patients received TEVAR in our institution. ELII was diagnosed in 30 patients (8.7%; 13 males; median age: 65 years, range: 24 to 84 years), representing the study population of this retrospective, single-center analysis. Mean follow-up was 29.5 months (range, 8 months to 9.5 years).
  
  
  RESULTS
  Primary ELII was observed in all but two cases (28/30; 93.3%). The most common sources of ELII were the left subclavian artery (LSA; 13/30; 43.3%) and intercostal/bronchial vessels (13/30; 43.3%), followed by visceral arteries (4/30; 13.4%). Overall mortality was 33.3% (10/30). ELII-related death (secondary rupture) was observed in 20% (2/10). Reintervention (RI) procedures for ELII were performed in 9 of 30 patients (30.0%); 5 of 9 (55.6%) in cases with ELII via the LSA. Indications for RI were diameter expansion in five and extensive leakage in four cases. Treatment was successful in five patients (55.6%) but failed in four cases (44.4%). In 12 of 21 (57.1%) untreated patients, ELII sealed during follow-up. In conservatively treated patients, an increase in aortic diameter has been only observed in a patient with secondary ELII.
  
  
  CONCLUSIONS
  The results presented herein suggest that the clinical impact of ELII after TEVAR must not be underestimated. Albeit a transient finding in most cases, ELII is associated with a relevant RI rate, particularly in cases involving the LSA. RI seems indicated in patients with increasing aortic diameter and/or extensive leakage. Careful surveillance of all patients with ELII is recommended.
authors.affiliation: Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Heidelberg, Germany. moritz.bischoff@med.uni-heidelberg
authors.forename: Moritz S
authors.initials: MS
authors.lastname: Bischoff
authors.forename: Philipp
authors.initials: P
authors.lastname: Geisbüsch
authors.forename: Drosos
authors.initials: D
authors.lastname: Kotelis
authors.forename: Matthias
authors.initials: M
authors.lastname: Müller-Eschner
authors.forename: Alexander
authors.initials: A
authors.lastname: Hyhlik-Dürr
authors.forename: Dittmar
authors.initials: D
authors.lastname: Böckler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult