title: Anatomic risk factors for type-2 endoleak following EVAR: a retrospective review of preoperative CT angiography in 326 patients.
abstract: OBJECTIVE
  We describe the anatomic characteristics on preoperative CT angiography (CTA) that predispose to type-2 endoleaks after endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysms (AAA).
  
  
  METHODS
  Between 1999 and 2010, 326 patients had a CTA before and after EVAR. CTAs were reviewed for maximal sac diameter, >50% circumferential luminal thrombus, and patency of the infrarenal aortic side branches, including the inferior mesenteric artery (IMA) and L2-L5 lumbar arteries. Postoperative CTAs were reviewed for a persistent type-2 endoleak.
  
  
  RESULTS
  Of 326 patients, 30.4% had a type-2 endoleak on CTA. Univariate analysis demonstrated a patent IMA, increased patent individual L2, L3, and L4 lumbar arteries, and an increased number of total patent lumbar arteries in patients with type-2 endoleak compared to those without (p < 0.001, 0.002, <0.001, <0.001, and <0.001 respectively). Sac diameter, patent L5 lumbar arteries, and >50% circumferential mural thrombus were not significantly different (p = 0.652, 0.617, and 0.16). Univariate logistic regression demonstrated increased risk of endoleak with each additional patent lumbar artery (odds ratio (OR) 1.26, p < 0.001). Multivariate analysis of the 326 patients resulted in the delineation of the optimal anatomic variables that predicted a type-2 endoleak: occluded L3 lumbar arteries (OR 0.1, p = 0.002), occluded L4 lumbar vertebral arteries (OR 0.31, p = 0.034), and IMA occlusion (OR 0.38, p = 0.008).
  
  
  CONCLUSIONS
  Univariate analysis demonstrated total patent lumbar arteries as a significant predictor of type-2 endoleak. Multivariate analysis demonstrated IMA occlusion, L3 lumbar artery occlusion, and L4 lumbar artery occlusion as independently protective against type-2 endoleak after EVAR.
authors.affiliation: Department of Interventional Radiology, Mount Sinai Medical Center, One Gustave L Levy Place, New York, NY, 10029, USA, thomasjward@gmail.com.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ward
authors.forename: Stuart
authors.initials: S
authors.lastname: Cohen
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Patel
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Fischman
authors.forename: Francis S
authors.initials: FS
authors.lastname: Nowakowski
authors.forename: Sharif H
authors.initials: SH
authors.lastname: Ellozy
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
authors.forename: Michael L
authors.initials: ML
authors.lastname: Marin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lookstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000792:Angiography / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D057867:Endoleak / Q000453:epidemiology* / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012077:Renal Artery / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome