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      Abdominal Aortic Aneurysm Type II Endoleaks

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          Abstract

          Type II endoleaks occur commonly following endovascular aneurysm repair (EVAR). Although they remain enigmatic, multiples studies have evaluated preoperative risk factors and strategies for prevention of type II endoleaks. Prophylactic treatment of type II endoleaks can include embolization of accessory arteries, as well as complete aneurysmal sac occlusion. Regular post-operative surveillance and screening for type II endoleaks with triple-phase CTA is the standard of care. Aneurysm size and growth rate are factors that predict whether a persistence type II endoleak is hemodynamically significant, and whether it requires treatment with percutaneous trans-lumbar or trans-arterial embolization techniques. Less commonly, type II endoleaks can be repaired using laparoscopic or open surgical ligation of feeder arterial branches. Emerging methods using endovascular aneurysm sac sealing technology may continue to alter the incidence and long-term management strategies of type II endoleaks. Here we review the latest strategies in the treatment of Type II endoleaks following EVAR.

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          Most cited references 32

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          The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines.

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            Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement.

            Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for abdominal aortic aneurysm (AAA).
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              Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes.

              Type 2 endoleak occurs in up to 20% of patients after endovascular aneurysm repair (EVAR), but its long-term significance is debated. We reviewed our experience to evaluate late outcomes associated with type 2 endoleak. During the interval January 1994 to December 2005, 873 patients underwent EVAR. Computed tomography (CT) scan assessment was performed 5 mm. Study end points included overall survival, aneurysm sac growth, reintervention rate, conversion to open repair, and abdominal aortic aneurysm (AAA) rupture. Preoperative variables and anatomic factors potentially associated with these endpoints were assessed using multivariate analysis. We identified 164 (18.9%) patients with early (at the first follow-up CT scan) type 2 endoleaks. Mean follow-up was 32.6 months. In 131 (79.9%) early type 2 endoleaks, complete and permanent leak resolution occurred 6 months. Transient type 2 endoleak (those that resolved 6 months) should be considered for more frequent follow-up or a more aggressive approach to reintervention.
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                Author and article information

                Journal
                101613243
                41650
                J Cardiovasc Dis Diagn
                J Cardiovasc Dis Diagn
                Journal of cardiovascular diseases & diagnosis
                2329-9517
                26 October 2016
                20 August 2016
                September 2016
                15 November 2016
                : 4
                : 5
                Affiliations
                [1 ]Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
                [2 ]Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri, USA
                Author notes
                [* ]Corresponding author: Mohamed A Zayed, Vascular and Endovascular Surgery, Washington University School of Medicine, St. Louis, Missouri, USA, Tel: 314-362-5648; Fax: 314-362-7363; zayedm@ 123456wustl.edu
                Article
                NIHMS824673
                10.4172/2329-9517.1000255
                5110147

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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