title: Persistent type II endoleak after EVAR: the predictive value of the AAA thrombus volume.
abstract: BACKGROUND
  Persistent type II endoleaks (ELIIp, ≥6 months) after an endovascular aneurysm repair (EVAR) can be associated with adverse outcomes. The aims of this study are the evaluation of the incidence of ELIIp, their preoperative morphological predictive features (PMF) and the post-EVAR abdominal aortic aneurysm (AAA) evolution in the presence of ELIIp.
  
  
  METHODS
  Patients underwent EVAR between 2008 and 2010 were prospectively collected. Cases with ELIIp (group A: AG) were identified. A control group without ELIIp (group B: BG), homogeneous for clinical characteristics, follow-up timing and methods (CTA and/or CEUS at 6.12 months and yearly thereafter) was retrospectively selected. The PMF evaluated by computed-tomography-angiography (CTA) were: AAA-diameter, number and diameter of AAA efferent patent vessels (EPV), AAA-total volume (TV), AAA-thrombus volume (THV) and TV/THV rate (%VR). Volumes were calculated by the dedicated vessels analysis software. AG and BG were compared. The primary endpoint was to evaluate the incidence of ELIIp. Secondary endpoints were to analyze the relation between PMF and ELIIp and to assess the post-EVAR AAA-evolution in the presence of ELIIp.
  
  
  RESULTS
  Between 2008 and 2010, 200 patients underwent EVAR to treat AAA electively. An ELIIp was detected in 35cases (17.5%) (AG). Twenty-seven patients (13.5%) were included in BG. An overall of 62 patients (GA+GB) were analyzed. The mean pre-operative AAA diameter and EPV were 58±11.6 mm and 5.5±1.8 mm, respectively. The mean TV and THV were 187±111.5 cc and 82±75 cc, respectively. The median %VR was 42.3%. ELIIp was correlated to EPV≥6 (χ2, p=.015) and %VR <40% (logistic regression, P=0.032). The mean follow-up was 22±9 months. Seven (20%) ELIIp spontaneously sealed and 6 (17%) required reinterventions (2 conversions to OR). There were not PMF associated to ELIIp evolution and AAA growth post-EVAR.
  
  
  CONCLUSIONS
  ELIIp is a not rare complication and it could require re-interventions. Our data suggest that VEP≥6 or %VT<40% are risk factors for ELIIp. No PMF was able to predict the ELIIp evolution. The relative high rate of re-interventions, could suggest the need of adjunctive/preventing primary procedures in patients at high-risk for ELIIp.
authors.affiliation: Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy - enrico.gallitto@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Gallitto
authors.affiliation: Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gargiulo
authors.affiliation: Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mascoli
authors.affiliation: Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Freyrie
authors.affiliation: Department of Radiology, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: DE Matteis
authors.affiliation: Unit of Ultrasound, Department of Internal Medicine and Gastroenterology, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Serra
authors.affiliation: Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bianchini Massoni
authors.affiliation: Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Faggioli
authors.affiliation: Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D015897:Comorbidity; D000072226:Computed Tomography Angiography; D003287:Contrast Media; D017558:Elective Surgical Procedures; D057867:Endoleak / Q000000981:diagnostic imaging / Q000453:epidemiology*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012984:Software; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003287:Contrast Media