title: The Impact of Aortic Tortuosity on Delayed Type I or III Endoleak after Endovascular Aortic Repair.
abstract: BACKGROUND
  Endovascular aneurysm repair (EVAR) becomes the treatment of choice for patients with abdominal aortic aneurysm (AAA). Type I or III endoleak is related to high risk of rupture and reintervention, but little is known about the delayed presentation of these. We sought to evaluate the delayed type I or III endoleak after EVAR and assess the early morphological portending factors.
  
  
  METHODS
  We retrospectively reviewed a database of 249 patients who underwent endovascular repair with a Zenith AAA stent graft (Cook Medical, Bloomington, IN) in a single institute from October 2005 to December 2013. Age, aneurysm size, angulation, tortuosity index (TI), and follow-up evaluations were recorded and analyzed. Patients having <1 year of follow-up were excluded.
  
  
  RESULTS
  One hundred eighteen patients were included in this study. There was no delayed type Ia endoleak. Ten patients (9.3%) were found to have a delayed type Ib or III endoleak. The mean diagnosis time was 49.1 months (range, 22-91 months) after EVAR. All of them were treated with endovascular repair except one had combined open revision. Three of the patients (30%) with delayed endoleaks presented with a ruptured aneurysm, and two of them (20%) died after reintervention. Postoperative TI was found to be the most significant morphological factor associated with increased risk of type Ib or III endoleak.
  
  
  CONCLUSIONS
  Delayed type Ib or III endoleak was not rare in our study population and was found to have a high risk of rupture and mortality. Aneurysm tortuosity is associated with increased risk of endoleaks, and postoperative TI can be an indicator in the early period of follow-up.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Cardiovascular Surgery Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Mennonite Christian Hospital, Hualien, Taiwan.
authors.forename: Hung-Lung
authors.initials: HL
authors.lastname: Hsu
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Yin-Yin
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Kuei-Yi
authors.initials: KY
authors.lastname: Chou
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Tzu-Ting
authors.initials: TT
authors.lastname: Kuo
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address: profccshih@gmail.com.
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Shih
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D000072226:Computed Tomography Angiography; D016208:Databases, Factual; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome