title: Metabolic syndrome is associated with type II endoleak after endovascular abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Type II endoleak is usually a benign finding after endovascular abdominal aortic aneurysm repair (EVAR). In some patients, however, type II endoleak leads to aneurysm sac expansion and the need for further intervention. We examined which factors, in particular the components of metabolic syndrome (MetS), would lead to an increase risk of endoleak after EVAR.
  
  
  METHODS
  The medical records of all patients who underwent EVAR between 2002 and 2011 at the Veterans Affairs Connecticut Healthcare System were reviewed. MetS was defined as the presence of three or more of the following: hypertension (blood pressure ≥130 mm Hg/≥90 mm Hg), serum triglycerides ≥150 mg/dL, serum high-density lipoproteins ≤50 mg/dL for women and ≤40 mg/dL for men, body mass index ≥30 kg/m(2), and fasting blood glucose ≥110 mg/dL. Development of endoleak, including specific endoleak type, was determined by review of standard radiologic surveillance.
  
  
  RESULTS
  During a 9-year period, 79 male patients (mean age, 73.5 years), underwent EVAR for infrarenal abdominal aortic aneurysm (mean 6.2 cm maximal transverse diameter). MetS was present in 52 patients (66%). The distribution of MetS factors among all patients was hypertension in 86%, hypertriglyceridemia in 72%, decreased high-density lipoprotein in 68%, diabetes in 37%, and a body mass index of ≥30 kg/m(2) in 30%. No survival difference was found between the MetS and non-MetS groups (P = .66). There was no difference in perioperative myocardial infarction or visceral ischemia immediately postoperatively between the two groups. Patients with MetS had a significant increase in acute kidney injury (n = 7, P = .0128). Endoleaks of all types were detected in 26% (n = 20) of all patients; patients with MetS had more endoleaks than patients without MetS (35% vs 7.4%, P = .0039). Of the 19 type II endoleaks, 79% were present at the time of EVAR and only 21% developed during surveillance; 95% had MetS (P = .0007).
  
  
  CONCLUSIONS
  Type II endoleak after EVAR for abdominal aortic aneurysm is associated with MetS. Whether these patients are subject to more subsequent intervention due to sac expansion is unclear. MetS may be a factor to consider in the treatment of type II endoleak.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Hall
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Protack
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Roland
authors.initials: R
authors.lastname: Assi
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Willis T
authors.initials: WT
authors.lastname: Williams
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wong
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lu
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn; Department of Surgery, Veterans Administration Connecticut Healthcare System, West Haven, Conn.
authors.forename: Bart E
authors.initials: BE
authors.lastname: Muhs
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn; Department of Surgery, Veterans Administration Connecticut Healthcare System, West Haven, Conn. Electronic address: alan.dardik@yale.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D057867:Endoleak / Q000209:etiology*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs