Embolization of Persistent Type 2 Endoleaks After Endovascular Treatment of Abdominal Aortic Aneurysms: A Study of Long-Term Success.

Endovascular treatment of abdominal aortic aneurysms (endovascular aneurysm repair [EVAR]) has been shown to be effective, with lower perioperative mortality and morbidity than open surgical treatment in patients with compatible anatomy. This benefit is lost after 3 years of follow-up. This could be explained by the higher rate of reintervention in EVAR patients due to endoleaks. Around half of patients with a persistent type 2 endoleak (T2EL) have an increase in aneurysm size. Either endovascular or conventional surgery techniques have been described to treat this type of endoleak. The aim of this study was to measure the long-term success rate of embolization of T2EL in a pragmatic retrospective series. A total of 592 patients underwent stent graft surgery at Centre Hospitalier Universitaire (CHU) Amiens Picardie during the study period. During follow-up, endoleaks were observed in 140 patients (25 type 1, 122 T2EL, 8 type 3, 1 type 4, and 4 type 5 endoleaks). Concerning T2EL type, 53 were not persistent. Treatment decision was ordered for 30 patients. Among them, 22 patients underwent primary embolization (73%), 7 patients underwent primary surgical treatment (23%), and 1 patient underwent emergency endovascular extension for aortic rupture. Technical success was achieved in all procedures (n = 22). After embolization, the median follow-up was 51 months [29.25-59.75]. At the end of the study, 8 patients (36%) were considered "clinical success" with no difference among embolization procedure, embolization agent used, or initial clinical characteristics. We report that the embolization procedures have a low clinical success rate during follow-ups. Further studies should investigate the etiologies of sac enlargement after embolization that could be related to a wrong categorization of initial endoleak.