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Intraoperative Type Ia Endoleaks Following Fenestrated Endovascular Aneurysm Repair are Not Associated with an Increased Aneurysm-Related Mortality or Need for Re-intervention
Bowen Xie, MS, Abhisekh Mohapatra, MD, Karim M. Salem, MD, Michael C. Madigan, MD, Richard E. Redlinger, MD, Rabih A. Chaer, MD, Michel S. Makaroun, MD, Michael J. Singh, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Objectives: Type Ia endoleaks are commonly found on completion aortogram following fenestrated endovascular abdominal aortic aneurysm repair (FEVAR). We sought to determine whether immediate type Ia endoleaks resolve spontaneously, and whether they are predictive of mortality or need for early re-intervention.
Methods: We conducted a retrospective review of patients who underwent FEVAR using a Zenith Fenestrated endograft (Cook Medical) at our institution between 2013 and 2016, post-commercial release. Baseline characteristics and preoperative, intraoperative, and postoperative data were collected including CT angiogram and duplex ultrasound examinations. The primary outcome was endoleak resolution at 30 days; secondary outcomes included aneurysm-related complications at one year.
Results: 49 patients underwent FEVAR; 4 were excluded for lack of follow-up. The remaining 45 were followed for a mean of 10.9 months. Mean aneurysm size was 59 mm; the proximal landing zone had mean diameter 25.3 mm (range 19.4-35 mm) and length 23.4 mm (range 10.8-61.3 mm). The main body device was appropriately oversized (median of 18%). A total of 21 endoleaks (46.6%) were identified intraoperatively: 13 type Ia, 5 type II, and 3 type III (between fenestration and bridging stent). Repeat angioplasty (done in 3 type Ia and 2 type III endoleaks) was unsuccessful. By 30 days, 11/13 (85%) type Ia endoleaks had resolved, although 3 were associated with residual type II endoleaks; all type III endoleaks had resolved. One persistent type Ia endoleak resolved on follow-up imaging at 7 months; the other patient expired from non-aneurysm related causes at 9 months. The one-year all-cause mortality rate was 11.2%; presence of type Ia endoleak was not associated with mortality (P = .30). There were no aneurysm-related deaths. Four patients (8.9%) required re-intervention, none of them to address type I or III endoleaks. 68% showed sac shrinkage (mean size 55 mm), with no difference between those with immediate endoleak and those without (P = .20).
Conclusions: Type Ia endoleaks are seen frequently on completion imaging at the time of FEVAR, possibly secondary to the anatomic complexity of the proximal landing zone. Most of these endoleaks resolved by 30 days, and were not associated with an increased aneurysm-related mortality or re-intervention rate at one year. Expectant management of immediate type Ia endoleaks after FEVAR appears to be appropriate.


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