Type Ⅱ endoleak originating from inferior mesenteric artery after endovascular abdominal aortic aneurysm repair: A retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yong ¹ ,  SUN Yan ²

1. Department of Radiology, Binzhou Second People's Hospital, Binzhou, 256800, Shandong, P. R. China;
2. Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P. R. China;

Corresponding author：

SUN Yan, Email: sdxueguan@163.com

Keywords：

Abdominal aortic aneurysm; endovascular repair; inferior mesenteric artery; type Ⅱ endoleak

DOI：

10.7507/1007-4848.202212036

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Objective To investigate the management experience of type Ⅱ endoleak originating from inferior mesenteric artery (IMA) after endovascular abdominal aortic aneurysm repair (EVAR). Methods The clinical data of patients with type Ⅱ endoleak originating from IMA after EVAR treated in the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from October 2016 to November 2021 were collected and analyzed. Results There were 12 males and 3 females at age of 57-89 (68.00±7.84) years. Eleven patients received embolization of the abdominal aortic aneurysm lumen and initial segment of the IMA via the superior mesenteric artery-middle colic artery-Riolan arch-left colic artery-IMA route. Three patients received embolization of the initial segment of the IMA by the above route. One patient underwent open dissection of the abdominal aortic aneurysm, and orifice of IMA was sutured in the aneurysm cavity while stents were retained. All 15 patients were successfully treated by surgery. The symptoms of back pain, abdominal pain and abdominal distension disappeared in 6 patients after surgery. Neither perioperative deaths nor complications happened during the treatment and follow-up period. The median follow-up time was 11.00 (9.00, 18.00) months. Two patients with typeⅡendoleak recurred during the follow-up period and were admitted to hospital for secondary embolization. No recurrence was observed at 12 months postoperative follow-up. Conclusion Type Ⅱ endoleak is one of the most common complications after EVAR. IMA is the most common criminal origin of typeⅡendoleak. TypeⅡendoleak that lead to persistent expansion of the aneurysm cavity requires aggressive intervention.

Citation： WANG Yong, SUN Yan. Type Ⅱ endoleak originating from inferior mesenteric artery after endovascular abdominal aortic aneurysm repair: A retrospective analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1462-1466. doi: 10.7507/1007-4848.202212036 Copy

1.	胡路, 陈学明, 刘明远, 等. 腔内修复术治疗复杂型腹主动脉瘤的疗效观察. 血管与腔内血管外科杂志, 2022, 8(6): 656-659, 670.Hu L, Chen XM, Liu MY, et al. Observation of the effect of endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysm. J Vasc Endovasc Surg, 2022, 8(6): 656-659, 670.
2.	郭强, 赵纪春, 黄斌. 腹主动脉瘤腔内修复术后Ⅱ型内漏的影响因素及处理. 血管与腔内血管外科杂志, 2021, 7(6): 643-647, 653.Guo Q, Zhao JC, Huang B. Impact factors and management of typeⅡendoleak after endovascular aneurysm repair of abdominal aortic aneurysm. J Vasc Endovasc Surg, 2021, 7(6): 643-647, 653.
3.	Moulakakis KG, Klonaris C, Kakisis J, et al. Treatment of typeⅡendoleak and aneurysm expansion after EVAR. Ann Vasc Surg, 2017, 39: 56-66.
4.	Sidloff DA, Gokani V, Stather PW, et al. Type Ⅱ endoleak: Conservative management is a safe strategy. Eur J Vasc Endovasc Surg, 2014, 48(4): 391-399.
5.	Sidloff DA, Stather PW, Choke E, et al. TypeⅡendoleak after endovascular aneurysm repair. Br J Surg, 2013, 100(10): 1262-1270.
6.	Samura M, Morikage N, Otsuka R, et al. Endovascular aneurysm repair with inferior mesenteric artery embolization for preventing typeⅡendoleak: A prospective randomized controlled trial. Ann Surg, 2020, 271(2): 238-244.
7.	Sheehan MK, Ouriel K, Greenberg R, et al. Are typeⅡendoleaks after endovascular aneurysm repair endograft dependent? J Vasc Surg, 2006, 43(4): 657-661.
8.	Nuckles B, Nadal L, Berger A, et al. Outcomes of typeⅡendoleak treatment using ethylene vinyl alcohol copolymer (OnyxTM). Vasc Endovascular Surg, 2021, 55(1): 50-57.
9.	Kray J, Kirk S, Franko J, et al. Role of typeⅡendoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg, 2015, 61(4): 869-874.
10.	Rayt HS, Sandford RM, Salem M, et al. Conservative management of type 2 endoleaks is not associated with increased risk of aneurysm rupture. Eur J Vasc Endovasc Surg, 2009, 38(6): 718-723.
11.	Wanhainen A, Verzini F, Van Herzeele I, et al. Editor's choice—European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 8-93.
12.	Pineda DM, Calligaro KD, Tyagi S, et al. Late typeⅡendoleaks after endovascular aneurysm repair require intervention more frequently than early typeⅡendoleaks. J Vasc Surg, 2018, 67(2): 449-452.
13.	Morisaki K, Yamaoka T, lwasa K, et a1. Preoperative risk factors for aneurysm sac expansion caused by type 2 endoleak after endovascular aneurysm repair. Vascular, 2017, 25(5): 533-541.
14.	Yu HYH, Lindström D, Wanhainen A, et al. Systematic review and meta-analysis of prophylactic aortic side branch embolization to prevent typeⅡendoleaks. J Vasc Surg, 2020, 72(5): 1783-1792.e1.
15.	Fukuda T, Matsuda H, Sanda Y, et a1. CT findings of risk factors for persistent typeⅡ endoleak from inferior mesenteric artery to determine indicators of preoperative IMA embolization. Ann Vasc Dis, 2014, 7(3): 274-279.
16.	Couchet G, Pereira B, Carrieres C, et al. Predictive factors for typeⅡendoleaks after treatment of abdominal aortic aneurysm by conventional endovascular aneurysm repair. Ann Vasc Surg, 2015, 29(8): 1673-1679.
17.	Piazza M, Squizzato F, Miccoli T, et al. Definition of typeⅡendoleak risk based on preoperative anatomieal characteristics. J Endovasc Ther, 2017, 24(4): 566-572.
18.	Piazza M, Squizzato F, Zavatta M, et al. Outcomes of endovascular aneurysm repair with contemporary volume. Dependent sac embolization in patients at risk for typeⅡendoleak. J Vasc Surg, 2016, 63(1): 32-38.
19.	Bryce Y, Schiro B, Cooper K, et al. TypeⅡendoleaks: Diagnosis and treatment algorithm. Cardiovasc Diagn Ther, 2018, 8: S131-S137.
20.	孙岩, 张十一, 金星, 等. 腹主动脉瘤腔内修复术后Ⅱ型内漏的诊治经验. 中华放射学杂志, 2012, 46(7): 652-653.Sun Y, Zhang SY, Jin X, et al. Diagnosis and treatment experience of typeⅡinternal leakage after endovascular repair of abdominal aortic aneurysm. Chin J Radiol, 2012, 46(7): 652-653.
21.	Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.
22.	Yamada M, Takahashi H, Tauchi Y, et al. Open surgical repair can be one option for the treatment of persistent typeⅡendoleak after EVAR. Ann Vasc Dis, 2015, 8(3): 210-214.
23.	Wu WW, Swerdlow NJ, Dansey K, et al. Surgical treatment patterns and clinical outcomes of patients treated for expanding aneurysm sacs with typeⅡendoleaks after endovascular aneurysm repair. J Vasc Surg, 2021, 73(2): 484-493.
24.	Charisis N, Bouris V, Conway AM, et al. A systematic review and pooled meta-analysis on the incidence and temporal occurrence of typeⅡendoleak following an abdominal aortic aneurysm repair. Ann Vasc Surg, 2021, 75: 406-419.
25.	Spanos K, Tsilimparis N, Larena-Avellaneda A, et al. Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of typeⅡendoleak after endovascular aortic aneurysm repair. J Vasc Surg, 2017, 66(6): 1878-1884.

1. 胡路, 陈学明, 刘明远, 等. 腔内修复术治疗复杂型腹主动脉瘤的疗效观察. 血管与腔内血管外科杂志, 2022, 8(6): 656-659, 670.Hu L, Chen XM, Liu MY, et al. Observation of the effect of endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysm. J Vasc Endovasc Surg, 2022, 8(6): 656-659, 670.
2. 郭强, 赵纪春, 黄斌. 腹主动脉瘤腔内修复术后Ⅱ型内漏的影响因素及处理. 血管与腔内血管外科杂志, 2021, 7(6): 643-647, 653.Guo Q, Zhao JC, Huang B. Impact factors and management of typeⅡendoleak after endovascular aneurysm repair of abdominal aortic aneurysm. J Vasc Endovasc Surg, 2021, 7(6): 643-647, 653.
3. Moulakakis KG, Klonaris C, Kakisis J, et al. Treatment of typeⅡendoleak and aneurysm expansion after EVAR. Ann Vasc Surg, 2017, 39: 56-66.
4. Sidloff DA, Gokani V, Stather PW, et al. Type Ⅱ endoleak: Conservative management is a safe strategy. Eur J Vasc Endovasc Surg, 2014, 48(4): 391-399.
5. Sidloff DA, Stather PW, Choke E, et al. TypeⅡendoleak after endovascular aneurysm repair. Br J Surg, 2013, 100(10): 1262-1270.
6. Samura M, Morikage N, Otsuka R, et al. Endovascular aneurysm repair with inferior mesenteric artery embolization for preventing typeⅡendoleak: A prospective randomized controlled trial. Ann Surg, 2020, 271(2): 238-244.
7. Sheehan MK, Ouriel K, Greenberg R, et al. Are typeⅡendoleaks after endovascular aneurysm repair endograft dependent? J Vasc Surg, 2006, 43(4): 657-661.
8. Nuckles B, Nadal L, Berger A, et al. Outcomes of typeⅡendoleak treatment using ethylene vinyl alcohol copolymer (OnyxTM). Vasc Endovascular Surg, 2021, 55(1): 50-57.
9. Kray J, Kirk S, Franko J, et al. Role of typeⅡendoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg, 2015, 61(4): 869-874.
10. Rayt HS, Sandford RM, Salem M, et al. Conservative management of type 2 endoleaks is not associated with increased risk of aneurysm rupture. Eur J Vasc Endovasc Surg, 2009, 38(6): 718-723.
11. Wanhainen A, Verzini F, Van Herzeele I, et al. Editor's choice—European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 8-93.
12. Pineda DM, Calligaro KD, Tyagi S, et al. Late typeⅡendoleaks after endovascular aneurysm repair require intervention more frequently than early typeⅡendoleaks. J Vasc Surg, 2018, 67(2): 449-452.
13. Morisaki K, Yamaoka T, lwasa K, et a1. Preoperative risk factors for aneurysm sac expansion caused by type 2 endoleak after endovascular aneurysm repair. Vascular, 2017, 25(5): 533-541.
14. Yu HYH, Lindström D, Wanhainen A, et al. Systematic review and meta-analysis of prophylactic aortic side branch embolization to prevent typeⅡendoleaks. J Vasc Surg, 2020, 72(5): 1783-1792.e1.
15. Fukuda T, Matsuda H, Sanda Y, et a1. CT findings of risk factors for persistent typeⅡ endoleak from inferior mesenteric artery to determine indicators of preoperative IMA embolization. Ann Vasc Dis, 2014, 7(3): 274-279.
16. Couchet G, Pereira B, Carrieres C, et al. Predictive factors for typeⅡendoleaks after treatment of abdominal aortic aneurysm by conventional endovascular aneurysm repair. Ann Vasc Surg, 2015, 29(8): 1673-1679.
17. Piazza M, Squizzato F, Miccoli T, et al. Definition of typeⅡendoleak risk based on preoperative anatomieal characteristics. J Endovasc Ther, 2017, 24(4): 566-572.
18. Piazza M, Squizzato F, Zavatta M, et al. Outcomes of endovascular aneurysm repair with contemporary volume. Dependent sac embolization in patients at risk for typeⅡendoleak. J Vasc Surg, 2016, 63(1): 32-38.
19. Bryce Y, Schiro B, Cooper K, et al. TypeⅡendoleaks: Diagnosis and treatment algorithm. Cardiovasc Diagn Ther, 2018, 8: S131-S137.
20. 孙岩, 张十一, 金星, 等. 腹主动脉瘤腔内修复术后Ⅱ型内漏的诊治经验. 中华放射学杂志, 2012, 46(7): 652-653.Sun Y, Zhang SY, Jin X, et al. Diagnosis and treatment experience of typeⅡinternal leakage after endovascular repair of abdominal aortic aneurysm. Chin J Radiol, 2012, 46(7): 652-653.
21. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.
22. Yamada M, Takahashi H, Tauchi Y, et al. Open surgical repair can be one option for the treatment of persistent typeⅡendoleak after EVAR. Ann Vasc Dis, 2015, 8(3): 210-214.
23. Wu WW, Swerdlow NJ, Dansey K, et al. Surgical treatment patterns and clinical outcomes of patients treated for expanding aneurysm sacs with typeⅡendoleaks after endovascular aneurysm repair. J Vasc Surg, 2021, 73(2): 484-493.
24. Charisis N, Bouris V, Conway AM, et al. A systematic review and pooled meta-analysis on the incidence and temporal occurrence of typeⅡendoleak following an abdominal aortic aneurysm repair. Ann Vasc Surg, 2021, 75: 406-419.
25. Spanos K, Tsilimparis N, Larena-Avellaneda A, et al. Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of typeⅡendoleak after endovascular aortic aneurysm repair. J Vasc Surg, 2017, 66(6): 1878-1884.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Type Ⅱ endoleak originating from inferior mesenteric artery after endovascular abdominal aortic aneurysm repair: A retrospective analysis in a single center

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