Outcome of endoleak following endoluminal abdominal aortic aneurysm repair.

ABSTRACT

BACKGROUND: The most important complication of endoluminal abdominal aortic aneurysm repair is endoleak, in which there is persistent blood flow outside the graft but within the aneurysm sac. Depending on endoleak type, there is an ongoing potential for aneurysm expansion or rupture. Conversely, some endoleaks may resolve spontaneously. Absolute indications for interventional management of endoleaks remain elusive due to the heterogeneous nature of leaks and uncertainty in predicting their outcome. METHODS: A retrospective review was conducted on all endoluminal graft recipients with endoleaks at Repatriation General Hospital over a 3-year period. Data were collected via a database maintained by the Department of Vascular Surgery, and hospital casenotes. RESULTS: Sixty-six patients underwent endoluminal graft insertion in the study period. Fourteen endoleaks were observed in 11 patients, representing an endoleak rate of 21.2%. There were three type I leaks and 11 type II leaks. One type I leak resolved spontaneously, one resolved immediately following interventional management, and one resolved 6 months after interventional management. Interventional treatment was undertaken in seven cases of type II leak due to increase in aneurysm diameter by 5 mm. Two type II endoleaks resolved spontaneously. Aneurysm diameter increased in two patients following radiographic resolution of their endoleaks. There were no cases of aneurysm rupture. CONCLUSIONS: Initial observation is a reasonable management option in most cases of type II endoleak, because some will spontaneously resolve during follow up. Those associated with increase in aneurysm size should undergo interventional treatment. Conservative management of type I endoleaks may be undertaken in extreme isolated cases.