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Late Type Ii Endoleaks After Evar Require Intervention More Frequently Than Early Type Ii Endoleaks
Danielle M. Pineda, Samuel Tyagi, MD, Douglas A. Troutman, DO, Matthew J. Dougherty, MD, Keith D. Calligaro, MD.
Pennsylvania Hospital, Philadelphia, PA, USA.

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Introduction: Type II endoleaks (T2Els) are common complications after endovascular abdominal aortic aneurysm repair (EVAR). We sought to determine if time of onset of T2Els correlated with the need to intervene based on sac expansion or rupture.
Methods: Between 1998-2015, we performed 462 EVARs that had complete duplex ultrasound (DU) follow-up. DU was used for routine surveillance and CT scans or arteriograms were reserved for abnormal DU findings. We analyzed the need for intervention forT2Els based on time of onset after EVAR. Interventions for T2Els were performed only for sac expansion > 0.5 mm or rupture. We defined late T2Els as being first observed beyond one year of follow-up.
Results: Of the 462 EVARs, 96 patients (21%) developed T2Els post-implant. Of these 96 patients, 65 (68%) had early and 31 (32%) had late T2Els (mean = 12 mos, range = 0 - 112). T2Els resolved without treatment in 75% (49/65) of early T2Els compared to only 29% (9/31) of late T2Els (p < 0.0001). Intervention was required for only 8% (5/65) of patients with early T2Els (5 sac expansion, 0 rupture) compared to 55% (17/31) for late T2Els (16 sac expansion, 1 rupture)(p < 0 .0001). The remaining patients are still being followed for persistent T2Els with no sac growth [17% (11/65) early versus 16% (5/31) late, p = 0.922].
Conclusion: T2Els that develop after one year required intervention much more frequently than those identified during the first post-procedure year. Less than one-third (29%) of T2Els that develop after one year will resolve spontaneously. T2Els that develop more than one year post-EVAR should be followed with a more frequent surveillance protocol and possibly with a lower threshold to intervene.


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