Philip S.K. Paty

The incidence and fate of endoleaks vary between ruptured and elective endovascular abdominal aortic aneurysm repair

Background: The number of ruptured abdominal aortic aneurysm (r‐AAA) patients who are treated by endovascular means is increasing as ruptured endovascular aneurysm repair (r‐EVAR) enters the mainstream. However, even today, data on the incidence and behavior of endoleaks after r‐EVAR are scarce. This study analyzed whether endoleaks behave differently after EVAR for rupture vs elective AAA repair. Methods: From 2002 to 2013, there were 2052 patients who underwent EVAR for treatment of rupture (n = 166 [8.1%]) and elective repair (n = 1886 [91.9%]) of infrarenal AAA. Follow‐up included computed tomography angiography at 1 month, at 6 months, and yearly thereafter. All type I and type III endoleaks were treated at the time of or shortly after the diagnosis. Persistent type II endoleaks at >6 months after EVAR without a decrease in AAA sac underwent translumbar or transfemoral embolization procedures. Data were prospectively collected in a vascular database. Results: During a mean follow‐up of 30 months, patients had a significantly lower incidence of type II endoleaks after r‐EVAR compared with elective endovascular aneurysm repair (e‐EVAR; n = 15 [9.0%] vs n = 380 [20.2%]; P < .01). Although the incidence of type I endoleaks is similar after r‐EVAR (n = 9 [5.4%] and e‐EVAR (n = 83 [4.4%]; P = .68), the r‐EVAR patients required stent graft explantation more frequently (n = 9 [5.4%] vs n = 20 [1.1%]; P < .01). Whereas the need for secondary intervention was comparable in both r‐EVAR (n = 33 [19.9%]) and e‐EVAR (n = 439 [23.3%]; P = .37) groups, patients undergoing percutaneous embolization procedures trended toward significance between the two groups (n = 11 [6.6%] vs n = 216 [11.5%]; P = .06) with endoleaks. Conclusions: Compared with e‐EVAR, patients who undergo r‐EVAR experience a similar incidence of type I endoleaks and a significantly lower incidence of type II endoleaks. The endoleaks in both e‐EVAR and r‐EVAR patients can frequently be managed by endovascular means. However, r‐EVAR patients with type I and type II endoleaks are at a significantly higher risk for stent graft explantation.