Persistent Type II Endoleaks Following Endovascular Aneurysm Repair: Graft Type Matters

Objectives:  Persistent type II endoleak is associated with increased risk of aneurysm growth and reintervention following endovascular aortic repair (EVAR).  Potential perioperative and graft-specific risk factors for type... [ view full abstract ]

Objectives:  Persistent type II endoleak is associated with increased risk of aneurysm growth and reintervention following endovascular aortic repair (EVAR).  Potential perioperative and graft-specific risk factors for type II endoleak development were assessed.   

Methods: A retrospective review of patients undergoing EVAR between 2008-2015 was performed.  Persistent type II endoleak was defined as the presence of a type II endoleak at 12 month follow up.  Patient demographics, procedural variables, and endograft types were collected.  Univariate and multivariate analysis was used to determine predictors of persistent type II endoleaks. 

Results: Two hundred and twenty three patients undergoing EVAR during this time period met inclusion criteria.  The overall incidence of type II endoleaks at the time of EVAR was 21.5 % (48/223).  At 12 months follow up the incidence remained similar at 21.3% (46/216, 7 patients had indeterminate endoleak).   The rates of persistent type II endoleaks were dependent on endograft type (p = 0.004): Cook Zenith 12.3% (8/65), Endologix AFX 0% (0/17), Gore Excluder 30.6% (26/91), Medtronic Endurant 24.5% (12/50).  On multivariate analysis, smoking status was independently protective ( p = 0.0061), and the Gore Excluder device was associated with a higher rate of type II endoleak (p < 0.01).

Conclusion: With current endograft iterations, short body configurations such as the Medtronic Endurant and the Gore Excluder had the highest rates of persistent type II endoleak (25 % and 31 %) while long body configurations such as the Cook Zenith and Endologix AFX had the lowest (12 % and 0% ).