Journal Article

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

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

2014

Overview

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.

• Publisher: Springer US,Springer Nature B.V
• Subject: Aged / Aged, 80 and over / Analysis of Variance / Angiography - methods / Aortic Aneurysm, Abdominal - diagnostic imaging / Aortic Aneurysm, Abdominal - mortality / Aortic Aneurysm, Abdominal - surgery / Cardiology / Clinical Investigation / Cohort Studies / Endoleak - epidemiology / Endoleak - etiology / Endovascular Procedures - adverse effects / Endovascular Procedures - methods / Female / Follow-Up Studies / Humans / Imaging / Linear Models / Male / Medicine / Medicine & Public Health / Mesenteric Artery, Inferior - anatomy & histology / Mesenteric Artery, Inferior - diagnostic imaging / Middle Aged / Multivariate Analysis / Nuclear Medicine / Odds Ratio / Postoperative Complications - epidemiology / Postoperative Complications - physiopathology / Predictive Value of Tests / Preoperative Care - methods / Radiology / Renal Artery - anatomy & histology / Renal Artery - diagnostic imaging / Retrospective Studies / Risk Assessment / Survival Rate / Tomography, X-Ray Computed - methods / Treatment Outcome / Ultrasound