title: Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes.
abstract: BACKGROUND
  Post-endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzed management and late outcomes of these endoleaks.
  
  
  METHODS
  This was a retrospective review of prospectively collected data from EVAR patients during a 10-year period. All post-EVAR type Ia endoleaks on completion angiogram were identified (group A) and their early (30-day) and late outcomes were compared with outcomes of patients without endoleaks (group B). Kaplan-Meier analysis was used for survival analysis, sac expansion, late type Ia endoleak, and reintervention.
  
  
  RESULTS
  Seventy-one of 565 (12.6%) patients had immediate post-EVAR type Ia endoleak. Early intervention (proximal aortic cuffs and/or stenting) was used in 56 of 71 (79%) in group A vs 31 of 494 (6%) in group B (p < 0.0001). Late type Ia endoleak was noted in 9 patients (13%) in group A at a mean follow-up of 28 months vs 10 patients (2%) in group B at a mean follow-up of 32 months (p < 0.0001). Late sac expansion and reintervention rates were 9% and 10% for group A vs 5% and 3% for group B (p = 0.2698 and p = 0.0198), respectively. Freedom rates from late type Ia endoleaks at 1, 3, and 5 years for group A were 88%, 85%, and 80% vs 98%, 98%, and 96% for group B (p < 0.001); and for late intervention, were 94%, 92%, and 77% for group A, and 99%, 97%, and 95% for group B (p = 0.007), respectively. Survival rates were similar.
  
  
  CONCLUSIONS
  Immediate post-EVAR type Ia endoleaks are associated with higher rates of early interventions, late endoleaks and reintervention, which will necessitate strict post-EVAR surveillance.
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WV. Electronic address: ali.aburahma@camc.org.
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WV.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hass
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WV.
authors.forename: Zachary T
authors.initials: ZT
authors.lastname: AbuRahma
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WV.
authors.forename: Michael
authors.initials: M
authors.lastname: Yacoub
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WV.
authors.forename: Albeir Y
authors.initials: AY
authors.lastname: Mousa
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WV.
authors.forename: Shadi
authors.initials: S
authors.lastname: Abu-Halimah
authors.affiliation: CAMC Health Education and Research Institute, Charleston, WV.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Dean
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WV.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D057867:Endoleak / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome