title: Type II endoleak: conservative management is a safe strategy.
abstract: OBJECTIVE
  Type II endoleak is the most common complication after endovascular abdominal aortic aneurysm repair (EVAR); however, its natural history is unclear. The aim of this study was to examine the incidence and outcomes of type II endoleak, at a single institution after EVAR.
  
  
  METHODS
  A total of 904 consecutive patients who underwent EVAR between September 1995 and July 2013 at a single centre were entered onto a prospective database. All patients were followed up by duplex ultrasound (DUSS). Patients who developed type II endoleak were compared for preoperative demographics, mortality, and sac expansion.
  
  
  RESULTS
  A total of 175(19%) patients developed type II endoleak over a median follow-up of 3.6 years (1.5-5.9 years); 54% of type II endoleaks spontaneously resolved within 6 months (0.25-1.2 years). No difference was found in preoperative demographics or choice of endograft between the two groups. Survival was significantly higher in the group with type II endoleak (94.1% vs. 85.6%; p = .01) and this effect was most pronounced in those with late type II endoleaks (97.7% vs. 85.6% p = .004). No difference was seen in aneurysm-related mortality or rate of type I endoleak between the two groups. Freedom from sac expansion (>5 mm from preoperative diameter) was significantly lower in the group of patients with type II endoleak (82.5% vs. 93.2%, p = .0001); however, at a threshold of >10 mm from preoperative diameter no difference was seen.
  
  
  CONCLUSIONS
  Patients with isolated type II endoleak demonstrate equivalent aneurysm-related mortality and an improved survival.
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. Electronic address: ds343@le.ac.uk.
authors.forename: D A
authors.initials: DA
authors.lastname: Sidloff
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: V
authors.initials: V
authors.lastname: Gokani
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: P W
authors.initials: PW
authors.lastname: Stather
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Choke
authors.affiliation: NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019468:Disease Management; D004621:Embolization, Therapeutic / Q000592:standards*; D057867:Endoleak / Q000175:diagnosis / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
keywords: AAA; Aneurysm; EVAR; Endoleak; Type II