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General Thoracic and Cardiovascular Surgery

Published in:

01-02-2014 | Current Topics Review Article

Secondary interventions following endovascular repair of abdominal aortic aneurysm

Authors: Naoki Toya, Yuji Kanaoka, Takao Ohki

Published in: General Thoracic and Cardiovascular Surgery | Issue 2/2014

Abstract

Endovascular aneurysm repair (EVAR) of the abdominal aortic aneurysms is an attractive alternative to open surgery with significantly improved perioperative outcomes. However, EVAR is accompanied by a higher rate of graft-related complications and secondary interventions. Therefore, life-long surveillance and management of secondary treatment is essential for successful EVAR. Endoleaks are one of the most crucial problems after EVAR. Persistent endoleaks are classified into five types and its management depends on the type and severity. Most persistent endoleaks are detectable by contrast-enhanced computed tomography; however, in some cases, two different endoleak types may coexist. Determining whether an endoleak requires any treatment or not is an important consideration. Most if not all type I and III endoleaks require prompt and definitive secondary treatment. While type II endoleaks are most commonly encountered during follow-up, not all type II endoleaks require invasive treatment. When secondary treatment is required, it can be treated endovascularly in most cases, even if there is no endoleak. Following EVAR, due to the decompression of the sac, the integrity of the aneurysmal wall strength reduces. Therefore, sudden sac expansion/rupture may occur when an endoleak is encountered following a period of complete aneurysmal exclusion. If diagnosed promptly most late complications can be treated in a less invasive manner, but it could lead to catastrophic event if it is missed. Therefore, adequate and life-long radiographic follow-up is as important as the appropriate patient and device selection as well as the EVAR procedure itself.

Greenhalgh RM, Brown LC, Kwong GPS, Powell JT, Thompson SG, EVAR trial participants. 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. 2004;364(9437):843–8.PubMedCrossRef

Prinssen M, Verhoeven ELG, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607–18.PubMedCrossRef

Ohki T, Veith FJ, Shaw P, et al. Increasing incidence of midterm and long-term complications after endovascular graft repair of abdominal aortic aneurysms: a note of caution based on a 9-year experience. Ann Surg. 2001;234(3):323–34 (discussion 334–5).PubMedCrossRef

Nordon IM, Karthikesalingam A, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM. Secondary interventions following endovascular aneurysm repair (EVAR) and the enduring value of graft surveillance. Eur J Vasc Endovasc Surg. 2010;39(5):547–54.PubMedCrossRef

Moulakakis KG, Dalainas I, Mylonas S, Giannakopoulos TG, Avgerinos ED, Liapis CD. Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction. J Endovasc Ther. 2010;17(6):694–702.PubMedCrossRef

Powell A, Benenati JF, Becker GJ, Katzen BT, Zemel G, Tummala S. Postoperative management: type I and III endoleaks. Tech Vasc Interv Radiol. 2001;4(4):227–31.PubMedCrossRef

Drury D, Michaels JA, Jones L, Ayiku L. Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br J Surg. 2005;92(8):937–46.PubMedCrossRef

Bashir MR, Ferral H, Jacobs C, McCarthy W, Goldin M. Endoleaks after endovascular abdominal aortic aneurysm repair: management strategies according to CT findings. AJR Am J Roentgenol. 2009;192(4):W178–86.PubMedCrossRef

Schlösser FJV, Gusberg RJ, Dardik A, et al. Aneurysm rupture after EVAR: can the ultimate failure be predicted? Eur J Vasc Endovasc Surg. 2009;37(1):15–22.PubMedCrossRef

10.

Faries PL, Cadot H, Agarwal G, Kent KC, Hollier LH, Marin ML. Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. J Vasc Surg. 2003;37(6):1155–61.PubMedCrossRef

11.

Tzortzis E, Hinchliffe RJ, Hopkinson BR. Adjunctive procedures for the treatment of proximal type I endoleak: the role of peri-aortic ligatures and Palmaz stenting. J Endovasc Ther. 2003;10(2):233–9.PubMedCrossRef

12.

Kirby L, Goodwin J. Treatment of a primary type IA endoleak with a liquid embolic system under conditions of aortic occlusion. J Vasc Surg. 2003;37(2):456–60.PubMedCrossRef

13.

Deaton DH, Mehta M, Kasirajan K, et al. The phase I multicenter trial (STAPLE-1) of the Aptus endovascular repair system: results at 6 months and 1 year. J Vasc Surg. 2009;49(4):851–7 discussion 857–8.PubMedCrossRef

14.

Bail DHL, Walker T, Giehl J. Vascular endostapling systems for vascular endografts (T)EVAR—systematic review—current state. Vasc Endovascular Surg. 2013;47(4):261–6.PubMedCrossRef

15.

Ohki T, Deaton DH, Condado JA. Aptus AAA repair system. Endovascular Today 2006;Nov:29–35.

16.

Cao P, Verzini F, Parlani G, et al. Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts. J Vasc Surg. 2003;37(6):1200–5.PubMedCrossRef

17.

Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002;35(5):1029–35.PubMedCrossRef

18.

Forbes TL, Harrington DM, Harris JR, DeRose G. Late conversion of endovascular to open repair of abdominal aortic aneurysms. Can J Surg. 2012;55(4):254–8.PubMedCentralPubMed

19.

Arthurs ZM, Lyden SP, Rajani RR, Eagleton MJ, Clair DG. Long-term outcomes of Palmaz stent placement for intraoperative type Ia endoleak during endovascular aneurysm repair. Ann Vasc Surg. 2011;25(1):120–6.PubMedCrossRef

20.

Ghouri M, Krajcer Z. Endoluminal abdominal aortic aneurysm repair: the latest advances in prevention of distal endograft migration and type 1 endoleak. Tex Heart Inst J. 2010;37(1):19–24.PubMedCentralPubMed

21.

Ahn JH, Kim JY, Jeon YS, et al. Successful treatment of type I endoleak of common iliac artery with balloon expandable stent (Palmaz XL stent) during endovascular aneurysm repair. J Korean Surg Soc. 2012;82(1):59–62.PubMedCentralPubMedCrossRef

22.

Bendermacher BLW, Stokmans R, Cuypers PW, Teijink JAW, Van Sambeek MRHM. EVAR reintervention management strategies in contemporary practice. J Cardiovasc Surg (Torino). 2012;53(4):411–8.

23.

Gallagher KA, Ravin RA, Meltzer AJ, et al. Midterm outcomes after treatment of type II endoleaks associated with aneurysm sac expansion. J Endovasc Ther. 2012;19(2):182–92.PubMedCrossRef

24.

Arko FR, Rubin GD, Johnson BL, Hill BB, Fogarty TJ, Zarins CK. Type-II endoleaks following endovascular AAA repair: preoperative predictors and long-term effects. J Endovasc Ther. 2001;8(5):503–10.PubMedCrossRef

25.

El Batti S, Cochennec F, Roudot-Thoraval F, Becquemin J-P. Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg. 2013;57(5):1291–7.PubMedCrossRef

26.

Patatas K, Ling L, Dunning J, Shrivastava V. Static sac size with a type II endoleak post-endovascular abdominal aortic aneurysm repair: surveillance or embolization? Interact Cardiovasc Thorac Surg. 2012;15(3):462–6.PubMedCrossRef

27.

Bonvini R, Alerci M, Antonucci F, et al. Preoperative embolization of collateral side branches: a valid means to reduce type II endoleaks after endovascular AAA repair. J Endovasc Ther. 2003;10(2):227–32.PubMedCrossRef

28.

Kasirajan K, Matteson B, Marek JM, Langsfeld M. Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J Vasc Surg. 2003;38(1):61–6.PubMedCrossRef

29.

Hansen CJ, Kim B, Aziz I, et al. Late-onset type II endoleaks and the incidence of secondary intervention. Ann Vasc Surg. 2004;18(1):26–31.PubMedCrossRef

30.

Stavropoulos SW, Carpenter JP, Fairman RM, Golden MA, Baum RA. Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol. 2003;14(9 Pt 1):1191–4.PubMedCrossRef

31.

Baum RA, Carpenter JP, Golden MA, et al. Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques. J Vasc Surg. 2002;35(1):23–9.PubMed

32.

Mansueto G, Cenzi D, D’Onofrio M, Petrella E, Gumbs AA, Mucelli RP. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: transcaval approach. Cardiovasc Interv Radiol. 2005;28(5):641–5.CrossRef

33.

Ellis PK, Kennedy PT, Collins AJ, Blair PH. The use of direct thrombin injection to treat a type II endoleak following endovascular repair of abdominal aortic aneurysm. Cardiovasc Interv Radiol. 2003;26(5):482–4.CrossRef

34.

Gambaro E, Abou-Zamzam AM, Teruya TH, Bianchi C, Hopewell J, Ballard JL. Ischemic colitis following translumbar thrombin injection for treatment of endoleak. Ann Vasc Surg. 2004;18(1):74–8.PubMedCrossRef

35.

van den Berg JC, Nolthenius RP, Casparie JW, Moll FL. CT-Guided thrombin injection into aneurysm sac in a patient with endoleak after endovascular abdominal aortic aneurysm repair. AJR Am J Roentgenol. 2000;175(6):1649–51.PubMedCrossRef

36.

van Nes JGH, Hendriks JM, Tseng LNL, van Dijk LC, van Sambeek MRHM. Endoscopic aneurysm sac fenestration as a treatment option for growing aneurysms due to type II endoleak or endotension. J Endovasc Ther. 2005;12(4):430–4.PubMedCrossRef

37.

Wisselink W, Cuesta MA, Berends FJ, van den Berg FG, Rauwerda JA. Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair. J Vasc Surg. 2000;31(6):1240–4.PubMedCrossRef

38.

Müller-Wille R, Wohlgemuth WA, Heiss P, et al. Transarterial embolization of type ii endoleaks after EVAR: the role of ethylene vinyl alcohol copolymer (Onyx). Cardiovasc Interv Radiol. 2013;36(5):1288–95.CrossRef

39.

Massis K, Carson WG, Rozas A, Patel V, Zwiebel B. Treatment of type II endoleaks with ethylene-vinyl-alcohol copolymer (Onyx). Vasc Endovascular Surg. 2012;46(3):251–7.PubMedCrossRef

40.

Stavropoulos SW, Park J, Fairman R, Carpenter J. Type 2 endoleak embolization comparison: translumbar embolization versus modified transarterial embolization. J Vasc Interv Radiol. 2009;20(10):1299–302.PubMedCrossRef

41.

Uthoff H, Katzen BT, Gandhi R, Peña CS, Benenati JF, Geisbüsch P. Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg. 2012;56(4):965–72.PubMedCrossRef

42.

Teutelink A, van der Laan MJ, Milner R, Blankensteijn JD. Fabric tears as a new cause of type III endoleak with Ancure endograft. J Vasc Surg. 2003;38(4):843–6.PubMedCrossRef

43.

Toya N, Fujita T, Kanaoka Y, Ohki T. Endotension following endovascular aneurysm repair. Vasc Med. 2008;13(4):305–11.PubMedCrossRef

44.

White GH, May J, Petrasek P, Waugh R, Stephen M, Harris J. Endotension: an explanation for continued AAA growth after successful endoluminal repair. J Endovasc Surg. 1999;6(4):308–15.PubMedCrossRef

45.

Parodi JC, Berguer R, Ferreira LM, La Mura R, Schermerhorn ML. Intra-aneurysmal pressure after incomplete endovascular exclusion. J Vasc Surg. 2001;34(5):909–14.PubMedCrossRef

46.

Lin PH, Bush RL, Katzman JB, et al. Delayed aortic aneurysm enlargement due to endotension after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003;38(4):840–2.PubMedCrossRef

47.

Kougias P, Bismuth J, Huynh TT, Lin PH. Symptomatic aneurysm rupture without bleeding secondary to endotension 4 years after endovascular repair of an abdominal aortic aneurysm. J Endovasc Ther. 2008;15(6):702–5.PubMedCrossRef

48.

Deaton DH. Improving proximal fixation and seal with the HeliFx Aortic EndoAnchor. Semin Vasc Surg. 2012;25(4):187–92.PubMedCrossRef

49.

Jim J, Rubin BG, Geraghty PJ, Criado FJ, Fajardo A, Sanchez LA. A 5-year comparison of EVAR for large and small aortic necks. J Endovasc Ther. 2010;17(5):575–84.PubMedCrossRef

50.

Brevetti LS, Nackman GB, Graham AM. Perirenal fixation as an independent factor in aortic remodeling after endovascular aortic aneurysm repair. Ann Vasc Surg. 2004;18(2):138–42.PubMedCrossRef

51.

Ohki T, Ouriel K, Silveira PG, et al. Initial results of wireless pressure sensing for endovascular aneurysm repair: the APEX Trial–Acute Pressure Measurement to Confirm Aneurysm Sac EXclusion. J Vasc Surg. 2007;45(2):236–42.PubMedCrossRef

52.

van Zeggeren L, Bastos Gonçalves F, van Herwaarden JA, et al. Incidence and treatment results of Endurant endograft occlusion. J Vasc Surg. 2013;57(5):1246–54.PubMedCrossRef

53.

Conway AM, Modarai B, Taylor PR, et al. Stent-graft limb deployment in the external iliac artery increases the risk of limb occlusion following endovascular AAA repair. J Endovasc Ther. 2012;19(1):79–85.PubMedCrossRef

54.

Karthikesalingam A, Kumar S, Anandarajah JJ, et al. Predictive value of peak systolic velocity for the development of graft limb complications after endovascular aneurysm repair. J Endovasc Ther. 2012;19(3):428–33.PubMedCrossRef

Title: Secondary interventions following endovascular repair of abdominal aortic aneurysm
Authors: Naoki Toya
Yuji Kanaoka
Takao Ohki
Publication date: 01-02-2014
Publisher: Springer Japan
Published in: General Thoracic and Cardiovascular Surgery / Issue 2/2014
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-013-0333-2

At a glance: The STEP trials

Springer Medicine

Secondary interventions following endovascular repair of abdominal aortic aneurysm

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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