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CardioVascular and Interventional Radiology

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01-04-2014 | Clinical Investigation

Anatomic Risk Factors for Type-2 Endoleak Following EVAR: A Retrospective Review of Preoperative CT Angiography in 326 patients

Authors: Thomas J. Ward, Stuart Cohen, Rahul S. Patel, Edward Kim, Aaron M. Fischman, Francis S. Nowakowski, Sharif H. Ellozy, Peter L. Faries, Michael L. Marin, Robert A. Lookstein

Published in: CardioVascular and Interventional Radiology | Issue 2/2014

Abstract

Purpose

We describe the anatomic characteristics on preoperative CT angiography (CTA) that predispose to type-2 endoleaks after endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysms (AAA).

Methods

Between 1999 and 2010, 326 patients had a CTA before and after EVAR. CTAs were reviewed for maximal sac diameter, >50 % circumferential luminal thrombus, and patency of the infrarenal aortic side branches, including the inferior mesenteric artery (IMA) and L2-L5 lumbar arteries. Postoperative CTAs were reviewed for a persistent type-2 endoleak.

Results

Of 326 patients, 30.4 % had a type-2 endoleak on CTA. Univariate analysis demonstrated a patent IMA, increased patent individual L2, L3, and L4 lumbar arteries, and an increased number of total patent lumbar arteries in patients with type-2 endoleak compared to those without (p < 0.001, 0.002, <0.001, <0.001, and <0.001 respectively). Sac diameter, patent L5 lumbar arteries, and >50 % circumferential mural thrombus were not significantly different (p = 0.652, 0.617, and 0.16). Univariate logistic regression demonstrated increased risk of endoleak with each additional patent lumbar artery (odds ratio (OR) 1.26, p < 0.001). Multivariate analysis of the 326 patients resulted in the delineation of the optimal anatomic variables that predicted a type-2 endoleak: occluded L3 lumbar arteries (OR 0.1, p = 0.002), occluded L4 lumbar vertebral arteries (OR 0.31, p = 0.034), and IMA occlusion (OR 0.38, p = 0.008).

Conclusions

Univariate analysis demonstrated total patent lumbar arteries as a significant predictor of type-2 endoleak. Multivariate analysis demonstrated IMA occlusion, L3 lumbar artery occlusion, and L4 lumbar artery occlusion as independently protective against type-2 endoleak after EVAR.

Sakalihasan N, Limet R, Defawe OD (2005) Abdominal aortic aneurysm. Lancet 365:1577–1589PubMedCrossRef

Hirsch AT, Haskal ZJ, Hertzer NR et al (2006) ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 47:1239–1312PubMedCrossRef

Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848PubMedCrossRef

United Kingdom ETI, Greenhalgh RM, Brown LC et al (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871PubMedCrossRef

Lederle FA, Freischlag JA, Kyriakides TC et al (2009) Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 302:1535–1542PubMedCrossRef

Albuquerque FC, Tonnessen BH, Noll RE, Cires G, Kim JK, Sternbergh WC (2010) Paradigm shifts in the treatment of abdominal aortic aneurysm: trends in 721 patients between 1996 and 2008. J Vasc Surg 51:1348–1353PubMedCrossRef

Schanzer A, Greenberg RK, Hevelone N et al (2011) Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 123:2848–2855PubMedCrossRef

Jones JE, Atkins MD, Brewster DC et al (2007) Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg 46:1–8PubMedCrossRef

Lewin RL, Fatterpekar G, Doshi A, Cohen E, Nowakowski F (2005) Anatomic risk factors for type 2 endoleak following EVAR: a retrospective review of CT angiography in 184 patients. Scientific Abstract presented at the RSNA Annual Meeting, Chicago

10.

Axelrod DJ, Lookstein RA, Guller J et al (2004) Inferior mesenteric artery embolization before endovascular aneurysm repair: technique and initial results. J Vasc Interv Radiol 15:1263–1267PubMedCrossRef

11.

Jackson R, Chang DC, Freischlag JA (2012) Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among medicare beneficiaries. JAMA 307:1621–1628PubMedCrossRef

12.

Arko FR, Rubin GD, Johnson BL, Hill BB, Fogarty TJ, Zarins CK (2001) Type-II endoleaks following endovascular AAA repair: preoperative predictors and long-term effects. J Endovasc Ther 8:503–510PubMedCrossRef

13.

Fan CM, Rafferty EA, Geller SC, Kaufman JA, Brewster DC, Cambria RP, Waltman AC (2001) Endovascular stent-graft in abdominal aortic aneurysms: the relationship between patent vessels that arise from the aneurysmal sac and early endoleak. Radiology 218:176–182PubMedCrossRef

14.

Görich J, Rilinger N, Sokiranski R et al (2001) Endoleaks after endovascular repair of aortic aneurysm: are they predictable? Initial results. Radiology 218:477–480PubMedCrossRef

15.

Marchiori A, von Ristow A, Guimaraes M, Schönholz C, Uflacker R (2011) Predictive factors for the development of type II endoleaks. J Endovasc Ther 18:299–305PubMedCrossRef

16.

Brountzos E, Karagiannis G, Panagiotou I, Tzavara C, Efstathopoulos E, Kelekis N (2012) Risk factors for the development of persistent type II endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms. Diagn Interv Radiol 18:307–313PubMed

17.

Marchiori A, von Ristow A, Guimaraes M, Schönholz C, Uflacker R (2011) Predictive factors for the development of type II endoleaks. J Endovasc Ther 18(3):299–305PubMedCrossRef

18.

Revel MP, Bissery A, Bienvenu M, Aycard L, Lefort C, Frija G (2004) Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable? Radiology 231(2):453–458PubMedCrossRef

19.

Erasmus JJ, Gladish GW, Broemeling L, Sabloff BS, Truong MT, Herbst RS, Munden RF (2003) Interobserver and intraobserver variability in measurement of non-small-cell carcinoma lung lesions: implications for assessment of tumor response. J Clin Oncol 21(13):2574–2582PubMedCrossRef

20.

Picozzi G, Diciotti S, Falchini M, Foresti S, Gallesi F, Cavigli E, Livi L, Villari N, Mascalchi M (2006) Operator-dependent reproducibility of size measurements of small phantoms and lung nodules examined with low-dose thin-section computed tomography. Invest Radiol 41(11):831–839PubMedCrossRef

21.

Bonvini R, Alerci M, Antonucci F et al (2003) Preoperative embolization of collateral side branches: a valid means to reduce type II endoleaks after endovascular AAA repair. J Endovasc Ther 10:227–232PubMedCrossRef

22.

Nevala T, Biancari F, Manninen H, Matsi P, Mäkinen K, Ylönen K, Perälä J (2010) Inferior mesenteric artery embolization before endovascular repair of an abdominal aortic aneurysm: effect on type II endoleak and aneurysm shrinkage. J Vasc Interv Radiol 21(2):181–185PubMedCrossRef

23.

Ward TJ, Cohen S, Fischman AM, Kim E, Nowakowski FS, Ellozy SH, Faries PL, Marin ML, Lookstein RA (2013) Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol 24(1):49–55PubMedCrossRef

Title: Anatomic Risk Factors for Type-2 Endoleak Following EVAR: A Retrospective Review of Preoperative CT Angiography in 326 patients
Authors: Thomas J. Ward
Stuart Cohen
Rahul S. Patel
Edward Kim
Aaron M. Fischman
Francis S. Nowakowski
Sharif H. Ellozy
Peter L. Faries
Michael L. Marin
Robert A. Lookstein
Publication date: 01-04-2014
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 2/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-013-0646-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anatomic Risk Factors for Type-2 Endoleak Following EVAR: A Retrospective Review of Preoperative CT Angiography in 326 patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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