The Risks and Consequences Of Type III Endoleaks

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L R. Sprouse II, MD¹, Jacob Buth, MD².
¹University of Tennessee, Chattanooga, TN, USA, ²Catharina Hospital, Eindhoven, The Netherlands.

BACKGROUND: Type III endoleaks result from modular disconnections or fabric tears of graft components following endovascular aortic repair (EVAR). Unlike other endoleaks, they represent a true mechanical failure of the endograft. The current study was undertaken to evaluate the risk factors associated with and consequences of type III endoleaks on patient outcome following EVAR.
METHODS: Patients included in the EUROSTAR registry with a post-operative type III endoleak (n = 88, 2.5%) were compared to those without the presence of any post-operative endoleak (n = 3,179). Clinical features, anatomical characteristics, procedural details, and outcome events were compared between the two groups. Multivariate analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Life table analysis was used to assess the incidence of time-related adverse events.
RESULTS: The cause of the type III endoleak was established in 55% (n = 48). Modular disconnect was confirmed in 42 and fabric tear in 6. Severe iliac angulation (OR 1.6/CI 1.1-2.4) and endoleak of any type identified by completion angiogram (OR 2.9/CI 1.8-4.7) were predictive for type III endoleak. Abnormal abdominal X-ray findings related to the endograft during follow-up were also predictive (P <.05). This included endograft limb angulation. The Zenith endograft was associated with a significantly decreased risk of type III endoleak (OR 0.6/CI0.3-0.9). The risk of persistent aneurysm growth, rupture, and conversion to open repair was significantly higher (P < .05) in patients with type III endoleak.
CONCLUSIONS: Type III endoleaks are infrequent. The procedural factors of severe iliac angulation and completion endoleak were predictive, while the third-generation, Zenith endograft was protective against type III endoleaks. Abdominal radiographs remain an important aspect of the routine follow-up after EVAR. Type III endoleaks are dangerous and warrant immediate intervention when detected.