Print this pageAn Eight-Year Experience With Type II Endoleaks: Natural History Suggests Selective Intervention Is A Safe Approach
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Donald T. Baril, MD, Daniel Silverberg, MD, Sharif H. Ellozy, MD, Alfio Carroccio, MD, Tikva S. Jacobs, MD, Victoria Teodorescu, MD, Savannah E. Greyrose, MS, Robert A. Lookstein, MD, Michael L. Marin, MD.
Mount Sinai School of Medicine, New York, NY, USA.
Objective: The natural history of type II endoleaks remains unclear. This study reviews all type II endoleaks following endovascular abdominal aortic repair (EVAR) at a single-institution.
Methods: Over an 8-year period, 965 patients underwent EVAR, of which 154 (16.0%) were found to have a type II endoleak. All type II endoleaks were documented by 3-phase CT angiography and, in select instances, with MR angiography. Data regarding patient characteristics, aneurysm size, device type, operative complications, and secondary interventions were reviewed. Outcomes evaluated included the rate of spontaneous sealing, freedom from secondary intervention, aneurysm enlargement, rupture or conversion.
Results: Type II endoleaks sealed spontaneously in 55 patients (35.7%) by a mean interval of 14.5 months. Overall mean follow-up was 22.0 months. A history of COPD or malignancy was associated with higher likelihood of spontaneous seal (p<.05). Nineteen patients (12.3%) with persistent type II endoleaks underwent embolotherapy. Thirteen of these patients experienced sac enlargement > 5 mm. No patient with a type II endoleak experienced rupture or conversion to open repair.
Conclusions: The rate of spontaneous seal of type II endoleaks increases with time. In the absence of sac expansion, close follow-up without intervention appears to be a safe approach. For patients in whom the exact etiology of their endoleak is unclear, dynamic imaging should be performed to exclude the presence of a type I endoleak. 