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RESEARCH PRODUCT

An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

Shirley KettingAleksandra C. ZoethoutDimitri ApostolouBarend MeesClark J. ZeebregtsMattia MigliariPatrick BergFrancesco TorellaJean-paul P.m. De VriesHazem El BeyroutiRoberto SilingardiMichel M.p.j. Reijnen

subject

medicine.medical_specialtymedicine.medical_treatmentTechnical successClinical Investigationsendoleak030204 cardiovascular system & hematologyProsthesis DesignEndovascular aneurysm repair030218 nuclear medicine & medical imagingendovascular aneurysm repair03 medical and health sciencesBlood Vessel Prosthesis Implantation0302 clinical medicineAneurysmabdominal aortic aneurysmRisk FactorsmedicineMANAGEMENTHumansabdominal aortic aneurysm; aneurysm; endoleak; endovascular aneurysm repair; reinterventionRadiology Nuclear Medicine and imagingRupture riskcardiovascular diseasesRetrospective StudiesreinterventionREPAIRAortic aneurysm repairABDOMINAL AORTIC-ANEURYSMSIncrease pressurebusiness.industryEndovascular ProceduresRetrospective cohort studymedicine.diseaseAbdominal aortic aneurysmSurgeryBlood Vessel ProsthesisTreatment Outcomecardiovascular systemaneurysmREPORTING STANDARDSSurgeryStentsCardiology and Cardiovascular MedicinebusinessAortic Aneurysm Abdominal

description

Introduction: Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR. Methods: This is an international, retrospective, observational cohort study including data from 8 European institutions. Results: A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5–89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%. Conclusion: The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.

yearjournalcountryeditionlanguage
2022-02-01Journal of Endovascular Therapy
10.1177/15266028211031933https://doi.org/10.1177/15266028211031933