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 < or =1 month of the operation and at
least annually thereafter. Sequential 6-month CT scan follow-up was adopted for those
patients with persistent type 2 endoleaks, and reintervention was limited to those
with sac enlargement >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 < or =6 months. Endoleaks persisted
in 33 patients (3.8% of total patients; 20.1% of early type 2 endoleaks) for >6 months.
Transient type 2 endoleak (those that resolved < or =6 months of EVAR) was not associated
with adverse late outcomes. In contrast, persistent endoleak was associated with several
adverse outcomes. AAA-related death was not significantly different between patients
with and without a type 2 endoleak (P = .78). When evaluating patients with no early
endoleak vs persistent endoleak, freedom from sac expansion at 1, 3, and 5 years was
99.2%, 97.6%, and 94.9% (no leak) vs 88.1%, 48.0%, and 28.0% (persistent) (P < .001).
Patients with persistent endoleak were at increased risk for aneurysm sac growth vs
patients without endoleak (odds ratio [OR], 25.9; 95% confidence interval [CI] 11.8
to 57.4; P < .001). Patients with a persistent endoleak also had a significantly increased
rate of reintervention (OR, 19.0; 95% CI, 8.0 to 44.7); P < .001). Finally, aneurysm
rupture occurred in 4 patients with type 2 endoleaks. Freedom from rupture at 1, 3,
and 5 years for patients with a persistent type 2 endoleak was 96.8%, 96.8%, and 91.1%
vs 99.8%, 98.5%, and 97.4% for patients without a type 2 endoleak. Multivariate analysis
demonstrated persistent type 2 endoleak to be a significant predictor of aneurysm
rupture (P = .03).
Persistent type 2 endoleak is associated with an increased incidence of adverse outcomes,
including aneurysm sac growth, the need for conversion to open repair, reintervention
rate, and rupture. These data suggest that patients with persistent type 2 endoleak
(>6 months) should be considered for more frequent follow-up or a more aggressive
approach to reintervention.