The Impact of Aortic Tortuosity on Delayed Type I or III Endoleak after Endovascular Aortic Repair.

ABSTRACT

BACKGROUND: Endovascular aneurysm repair (EVAR) becomes the treatment of choice for patients with abdominal aortic aneurysm (AAA). Type I or III endoleak is related to high risk of rupture and reintervention, but little is known about the delayed presentation of these. We sought to evaluate the delayed type I or III endoleak after EVAR and assess the early morphological portending factors. METHODS: We retrospectively reviewed a database of 249 patients who underwent endovascular repair with a Zenith AAA stent graft (Cook Medical, Bloomington, IN) in a single institute from October 2005 to December 2013. Age, aneurysm size, angulation, tortuosity index (TI), and follow-up evaluations were recorded and analyzed. Patients having <1 year of follow-up were excluded. RESULTS: One hundred eighteen patients were included in this study. There was no delayed type Ia endoleak. Ten patients (9.3%) were found to have a delayed type Ib or III endoleak. The mean diagnosis time was 49.1 months (range, 22-91 months) after EVAR. All of them were treated with endovascular repair except one had combined open revision. Three of the patients (30%) with delayed endoleaks presented with a ruptured aneurysm, and two of them (20%) died after reintervention. Postoperative TI was found to be the most significant morphological factor associated with increased risk of type Ib or III endoleak. CONCLUSIONS: Delayed type Ib or III endoleak was not rare in our study population and was found to have a high risk of rupture and mortality. Aneurysm tortuosity is associated with increased risk of endoleaks, and postoperative TI can be an indicator in the early period of follow-up.