A multi-institutional survey of interventional radiology for type II endoleaks after endovascular aortic repair: questionnaire results from the Japanese Society of Endoluminal Metallic Stents and Grafts in Japan.
OBJECTIVE
To investigate the current status of interventional radiology (IR) procedures for a type II endoleak (T2EL) in Japan, and to identify the technical aspects that affect treatment results.


METHODS
A retrospective survey was conducted by distributing questionnaires to 25 institutions. The eligibility criteria were endovascular aortic repair (EVAR) performed using commercial stent grafts and IR performed for T2EL between January 2007 and December 2013. Technical success was defined as disappearance of the EL on digital subtraction angiography immediately after embolization, and imaging success was defined as no EL on contrast-enhanced computed tomography within 6 months. Statistical comparisons of the number of involved branches, embolization level, embolic material, and changes in aneurysm size were made between the imaging success and imaging failure groups. The technical and imaging success rates were also compared between the initial therapy and repeat groups.


RESULTS
A total of 166 cases were investigated. Initial therapy was performed in 147 cases (88.6 %), with repeat therapy in 19 cases (11.4 %). Transcatheter arterial embolization (TAE) was used most frequently, in 161 cases (97 %), with direct puncture (DP) used in 5 cases (3 %). Both coil embolization for the branches and NBCA embolization for the sac were frequently chosen. The technical success rate was 83.2 % (TAE group), and the imaging success rate was 46.5 % (TAE + DP groups). Branch + sac embolization was performed more frequently in the imaging success group. There was no significant difference in the number of involved branches or embolic material between the imaging success and imaging failure groups. Enlargement of the aneurysm was more frequently seen in the imaging failure group. There were no significant differences in the technical success and imaging success rates between the initial therapy and repeat groups.


CONCLUSIONS
This is the first report of a multi-institutional questionnaire survey of IR procedures for T2EL after EVAR in Japan that was conducted to determine the current status. Enlargement of aneurysm size after embolization was more frequently seen in the imaging failure group. It is important to embolize both branch and sac to achieve imaging success, regardless of embolic material. Long-term outcomes need to be investigated.
Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan. yukky.oct.22@gmail.com.
Yukihisa
Y
Ogawa
Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Hiroshi
H
Nishimaki
Department of Radiology, Osaka University, Suita, Japan.
Keigo
K
Osuga
Department of Radiology, Kumamoto University, Kumamoto, Japan.
Osamu
O
Ikeda
Department of Radiology, Oita University, Yufu, Japan.
Norio
N
Hongo
Department of Radiology, Nara Medical University, Kashihara, Japan.
Shinichi
S
Iwakoshi
Department of Radiology, Hyogo Brain and Heart Center at Himeji, Himeji, Japan.
Ryota
R
Kawasaki
Department of Radiology, Kitasato University, Sagamihara, Japan.
Reiko
R
Woodhams
Department of Radiology, Kobe University, Kobe, Japan.
Masato
M
Yamaguchi
Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Mika
M
Kamiya
Department of Radiology, Gifu University, Gifu, Japan.
Masayuki
M
Kanematsu
Department of Radiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
Masanori
M
Honda
Department of Radiology, Tottori University, Yonago, Japan.
Toshio
T
Kaminou
Department of Radiology, Tokai University, Isehara, Japan.
Jun
J
Koizumi
Department of Radiology, Nara Medical University, Kashihara, Japan.
Kimihiko
K
Kichikawa
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000628:therapy*; D001027:Aortography; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D057867:Endoleak / Q000000981:diagnostic imaging*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D015642:Radiology, Interventional / Q000379:methods*; D012189:Retrospective Studies; D012955:Societies, Medical; D015607:Stents; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media
Endovascular abdominal aortic repair; Interventional radiology; Multi-institutional survey; Questionnaire; Type II endoleak