Computed tomography angiography surveillance for conservative endoleak treatment following complex endovascular aneurysm repair.

OBJECTIVE: To assess the spontaneous endoleak (EL) resolution rate and its associated factors in patients without aneurysm sac enlargement undergoing imaging surveillance with computed tomography angiography (CTA) following complex endovascular aneurysm repair procedures.

METHODS: A retrospective analysis of 230 consecutive patients at a single institution was undertaken. In patients with type I/III/mixed EL at predischarge CTA without aneurysm sac enlargement, CTA surveillance was scheduled in 6 months after index procedure. Indication for secondary reintervention was given provided aneurysm sac enlargement of >5 mm in 6 months or >10 mm after 12 months. The primary end point was the EL resolution rate during follow-up. Secondary end points were patient-related, periprocedural, and morphological factors of spontaneous EL resolution over time.

RESULTS: Predischarge CTAs have revealed ELs of any type in 75% of patients. Type I ELs did not resolve spontaneously over time. Type III ELs resolved spontaneously in 83% of cases at 24 months after the index procedure, with most resolution events being observed during the first 12 postinterventional months. Among mixed ELs, a combination of II/III ELs was found to resolve spontaneously over time (50% at 12 months). Spontaneous resolution between small (<9.37 mL) and large (>9.37 mL) volume ELs was compared, demonstrating at first no difference at 12 months and a tendency of faster EL resolution thereafter for small volume ELs. Maximum aortic diameter (P = .011), aneurysm sac shrinkage (P ≤ .001) and history of peripheral artery disease (P = .007) were found to be independent predictive factors of EL remission. No aneurysm sac rupture has been observed.

CONCLUSIONS: Provided stable aneurysm sac dynamics, CTA surveillance might be considered for patients presenting type III EL or mixed type II/III EL at predischarge CTA scan.