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      Type II endoleaks: challenges and solutions

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          Abstract

          Type II endoleaks are the most common endovascular complications of endovascular abdominal aortic aneurysm repair (EVAR); however, there has been a divided opinion regarding their significance in EVAR. Some advocate a conservative approach unless there is clear evidence of sac expansion, while others maintain early intervention is best to prevent adverse late outcomes such as rupture. There is a lack of level-one evidence in this challenging group of patients, and due to a low event rate of complications, large numbers of patients would be required in well-designed trials to fully understand the natural history of type II endoleak. This review will discuss the imaging, management, and outcome of patients with isolated type II endoleaks following infra-renal EVAR.

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          Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.

          F Moll, J T Powell, G Fraedrich … (2011)
          Article 0 comments Cited 224 times – based on 0 reviews     Review now
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            A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients.

            Eric Steinmetz, , Marc Sapoval … (2011)
            Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of reinterventions. Thus, the role of EVAR, most notably in low-risk patients, remains debated. The ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery. A total of 316 patients with >5 cm aneurysms were randomized in institutions with proven expertise for both treatments: 299 patients were available for analysis, and 149 were assigned to OSR and 150 to EVAR. Patients were monitored for 5 years after treatment. Statistical analysis was by intention to treat. With a median follow-up of 3 years (range, 0-4.8 years), there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR: 95.9% ± 1.6% vs 93.2% ± 2.1% at 1 year and 85.1% ± 4.5% vs 82.4% ± 3.7% at 3 years, respectively (P = .09). In-hospital mortality (0.6% vs 1.3%; P = 1.0), survival, and the percentage of minor complications were not statistically different. In the EVAR group, however, the crude percentage of reintervention was higher (2.4% vs 16%, P < .0001), with a trend toward a higher aneurysm-related mortality (0.7% vs 4%; P = .12). In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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              Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm.

              P Stather, D A Sidloff, N. Dattani … (2013)
              Any possible long-term benefit from endovascular (EVAR) versus open surgical repair for abdominal aortic aneurysm (AAA) remains unproven. Long-term data from the Open Versus Endovascular Repair (OVER) trial add to the debate regarding long-term all-cause and aneurysm-related mortality. The aim of this study was to investigate 30-day and long-term mortality, reintervention, rupture and morbidity after EVAR and open repair for AAA in a systematic review.
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Vasc Health Risk Manag
                Journal ID (iso-abbrev): Vasc Health Risk Manag
                Journal ID (publisher-id): Vascular Health and Risk Management
                Title: Vascular Health and Risk Management
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6344
                ISSN (Electronic): 1178-2048
                Publication date Collection: 2016
                Publication date (Electronic): 02 March 2016
                Volume: 12
                Pages: 53-63
                Affiliations
                [1 ]Department of Vascular Surgery, Queens Medical Centre, University of Nottingham, Nottingham, UK
                [2 ]Department of Cardiovascular Sciences, National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
                Author notes
                Correspondence: David A Sidloff, Department of Cardiovascular Sciences, Level 2, RKCSB, Leicester Royal Infirmary, Infirmary Square, Leicester, LE2 7LX, UK, Tel +44 773 683 3606, Email ds343@ 123456le.ac.uk
                Article
                Publisher ID: vhrm-12-053
                DOI: 10.2147/VHRM.S81275
                PMC ID: 4780400
                PubMed ID: 27042087
                SO-VID: ba8527f0-cde8-4d72-bcb9-f18e44a87580
                Copyright © © 2016 Brown et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Review

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: aorta,endovascular,endograft,endoleak,embolization
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: aorta, endovascular, endograft, endoleak, embolization

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