For patients undergoing endovascular aneurysm repair (EVAR), late appearing type 1A endoleaks were associated with a high rate of rupture. These findings, from a retrospective review of patient data, were published in the Annals of Vascular Surgery.

Patients (N=411) who underwent EVAR at Massachusetts General Hospital between 2010 and 2018 were reviewed for endoleaks. Late leaks were defined as developing over 1 year after EVAR and early leaks as less than 1 month of the procedure. Long-term freedom from endoleaks and clinical outcomes were assessed.

A total of 4 early and 20 late type 1A endoleaks were observed. The endoleaks and control cohorts comprised patients with a mean age of 76.2 and 75.3 years; 90% and 81% were men; and 95% and 98% were White individuals, respectively. The 2 cohorts differed significantly for aortic diameter (P <.001).


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Freedom from type 1A endoleaks was 99% at year 1, 92% at year 5, and 81% at year 8. The median time to occurrence was 2.5 years (range, 3 days-8.2 years).

Late type 1A endoleaks associated with neck diameter greater than 28 mm (hazard ratio [HR], 3.5; 95% CI, 1.2-10.3; P=.02), neck angle greater than 60° (HR, 3.4; 95% CI, 1.5-7.9; P =.004), neck length less than 20 mm (HR, 3.0; 95% CI, 1.1-8.6; P =.04), and age (HR, 1.07; 95% CI, 1.02-1.12 per year; P =.01). Patients with late type 1A endoleaks had previously undergone at least 1 reintervention (65%).

Most (65%) patients underwent repair of their late type 1A endoleak, 25% of which were open conversions. Among the patients who did not undergo open conversion (n=7), 1 was awaiting a custom-made fenestrated endovascular aneurysm repair device at the time of study publication, 2 died, 1 was under surveillance for a small leak, and 3 declined further participation in the study.

After diagnosis of a late type 1A endoleak, the median survival was 6.6 years (0 days-8.2 years). Stratified by repair, median survival was 6.6 years for those who underwent repair and 3.6 years for those who did not.

This study was limited by the small number of endoleaks overall, making comparisons about treatment strategies unfeasible.

The study authors concluded that following EVAR, type 1A endoleaks can occur up to nearly a decade after intervention and that hostile neck anatomy was a significant contributor. Patients who develop late type 1A endoleaks should undergo open conversion in order to increase long-term survival.

“Late [t]ype 1A endoleaks represent a significant diagnostic challenge, and demonstrate the need for lifelong, careful surveillance,” the study authors said.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

O’Donnell TFX, McElroy IE, Mohebali J, et al. Late type 1A endoleaks: associated factors, prognosis and management strategies. Ann Vasc Surg. 2021;S0890-5096(21)00784-6. doi:10.1016/j.avsg.2021.08.057