Risk factors of type 1A endoleak following endovascular aortic aneurysm repair.

OBJECTIVES: Endovascular repair of infrarenal aortic aneurysms are the treatment of first choice. However, the proximal sealing of endovascular aneurysm repair is the Achilles' heel of the procedure. Insufficient proximal sealing can lead to endoleak type 1A and therefore expansion of the aneurysm sack and subsequent rupture.

METHODS: We performed a retrospective analysis of all consecutive patients with an infrarenal abdominal aneurysm treated with endovascular aneurysm repair. We studied whether demographic and anatomical features were risk factors for endoleak type 1A. Also, the results of different treatment strategies were described.

RESULTS: 257 Patients were included in the study, most patients were male. In the multivariate analysis, female gender and infrarenal angulation were the most important risk factors for endoleak type 1A. Endoleak type 1A diagnosed at completion angiography disappeared in 77.8%. The occurrence of endoleak type 1A was associated with a higher risk of aneurysm-related mortality (p = 0.01).

CONCLUSION: Conclusions should be drawn with care, since the number of patients included in this study was small and there was a high incidence of patients lost to follow-up. This study suggests that endovascular aneurysm repair in female patients and patients with severe infrarenal angulation is associated with a higher risk of endoleak type 1A.