Effectiveness of coiling in the treatment of endoleaks after endovascular repair.

ABSTRACT

BACKGROUND: Persistent endoleaks are a common problem following endovascular repair of abdominal aortic aneurysms, and the best method of treatment has been an issue of debate. Some experimental evidence has suggested that coiling may not be an effective method because it allows transmission of pressure across the coils with continued expansion of the sac. We reviewed our experience with endoleak coiling to assess the degree of clinical success of this treatment. METHODS: A retrospective review of patients with type I or type II endoleaks treated solely by coiling over a 7-year period (1997-2003) was performed. All endoleaks had been observed for at least 6 months prior to intervention to detect spontaneous resolution. All coils were delivered by selective catheterization of the endoleaks. For Type II endoleaks, the branches were all coiled at their junction with the sac when feasible and the endoleak cavity was packed. Clinical success was defined as cessation of endoleak on follow-up computed tomography as well as no further aneurysmal growth (> or =5mm minor axis). RESULTS: Twenty-eight patients had their endoleaks treated only with coils. There were 22 Ancure, 2 Excluder, 2 AneuRx, and 2 Lifepath endografts in this patient cohort. Procedural morbidity was 0%. Mean follow-up after coiling for all patients was 18 months (range, 1-60 months) while mean follow-up for patients with a type I endoleak was 24 months. Clinical success was achieved in 15 of 19 (79%) patients with type II endoleaks and 8 of 9 (89%) patients with type I. Three patients, all with type I endoleak, required more than 1 episode of coiling, while 2 others, both with type II lumbar endoleaks, required repeat angiography due to inability to access the leak during the first attempt. There were 2 proximal and 6 distal type I endoleaks (2 aortic, 6 iliac) successfully treated while the type II successes included 8 inferior mesenteric artery and 7 sole lumbar endoleaks. Five patients continued to show evidence of endoleak over time 2 endoleaks were associated with aneurysm growth leading to conversion in 1 patient, 2 patients with type II endoleaks are stable, and the sole type I endoleak with continued perigraft flow has shown significant shrinkage of the sac and continues to be observed 18 months later. No ruptures were noted during follow-up. CONCLUSION: Coiling as the sole method of endoleak management may be a suitable treatment option in selected patients. Clinical success can be expected in over 80% of patients with type II and select type I endoleaks, with minimal morbidity.