TY - JOUR
T1 - Type 2 Endoleak With or Without Intervention and Survival After Endovascular Aneurysm Repair
AU - Mulay, Sana
AU - Geraedts, Anna C. M.
AU - Koelemay, Mark J. W.
AU - Balm, Ron
AU - Balm, R.
AU - Elshof, J. W.
AU - Elsman, B. H. P.
AU - Hamming, J. F.
AU - Koelemay, M. J. W.
AU - Kropman, R. H. J.
AU - Poyck, P. P.
AU - Schurink, G. W. H.
AU - de Smet, A. A. E. A.
AU - van Sterkenburg, S. M.
AU - Ünlü, C.
AU - Vahl, A. C.
AU - Verhagen, H. J. M.
AU - Vriens, P. W. H. E.
AU - de Vries, J. P. P. M.
AU - ODYSSEUS study group
AU - Wever, J. J.
AU - Wisselink, W.
AU - Zeebregts, C. J.
N1 - Funding Information: This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw; grant 843004119 ); ZonMw was not involved in the study design, data collection, data analysis, interpretation of results or preparation of this manuscript. Publisher Copyright: © 2021 The Authors
PY - 2021/5
Y1 - 2021/5
N2 - Objective: The aims of the present study were to examine the impact of type 2 endoleaks (T2EL) on overall survival and to determine the need for secondary intervention after endovascular aneurysm repair (EVAR). Methods: A multicentre retrospective cohort study in the Netherlands was conducted among patients with an infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between 2007 and 2012. The primary endpoint was overall survival for patients with (T2EL+) or without (T2EL-) a T2EL. Secondary endpoints were sac growth, AAA rupture, and secondary intervention. Kaplan–Meier survival and multivariable Cox regression analysis were used. Results: A total of 2 018 patients were included. The median follow up was 62.1 (range 0.1 – 146.2) months. No difference in overall survival was found between T2EL+ (n = 388) and T2EL- patients (n = 1630) (p =.54). The overall survival estimates at five and 10 years were 73.3%/69.4% and 45.9%/44.1% for T2EL+/T2EL- patients, respectively. Eighty-five of 388 (21.9%) T2EL+ patients underwent a secondary intervention. There was no difference in overall survival between T2EL+ patients who underwent a secondary intervention and those who were treated conservatively (p =.081). Sac growth was observed in 89 T2EL+ patients and 44/89 patients (49.4%) underwent a secondary intervention. In 41/44 cases (93.1%), sac growth was still observed after the intervention, but was left untreated. Aneurysm rupture occurred in 4/388 T2EL patients. In Cox regression analysis, higher age, ASA classification, and maximum iliac diameter were significantly associated with worse overall survival. Conclusion: No difference in overall survival was found between T2EL+ and T2EL- patients. Also, patients who underwent a secondary intervention did not have better survival compared with those who did not undergo a secondary intervention. This study reinforces the need for conservative treatment of an isolated T2EL and the importance of a prospective study to determine possible advantages of the intervention.
AB - Objective: The aims of the present study were to examine the impact of type 2 endoleaks (T2EL) on overall survival and to determine the need for secondary intervention after endovascular aneurysm repair (EVAR). Methods: A multicentre retrospective cohort study in the Netherlands was conducted among patients with an infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between 2007 and 2012. The primary endpoint was overall survival for patients with (T2EL+) or without (T2EL-) a T2EL. Secondary endpoints were sac growth, AAA rupture, and secondary intervention. Kaplan–Meier survival and multivariable Cox regression analysis were used. Results: A total of 2 018 patients were included. The median follow up was 62.1 (range 0.1 – 146.2) months. No difference in overall survival was found between T2EL+ (n = 388) and T2EL- patients (n = 1630) (p =.54). The overall survival estimates at five and 10 years were 73.3%/69.4% and 45.9%/44.1% for T2EL+/T2EL- patients, respectively. Eighty-five of 388 (21.9%) T2EL+ patients underwent a secondary intervention. There was no difference in overall survival between T2EL+ patients who underwent a secondary intervention and those who were treated conservatively (p =.081). Sac growth was observed in 89 T2EL+ patients and 44/89 patients (49.4%) underwent a secondary intervention. In 41/44 cases (93.1%), sac growth was still observed after the intervention, but was left untreated. Aneurysm rupture occurred in 4/388 T2EL patients. In Cox regression analysis, higher age, ASA classification, and maximum iliac diameter were significantly associated with worse overall survival. Conclusion: No difference in overall survival was found between T2EL+ and T2EL- patients. Also, patients who underwent a secondary intervention did not have better survival compared with those who did not undergo a secondary intervention. This study reinforces the need for conservative treatment of an isolated T2EL and the importance of a prospective study to determine possible advantages of the intervention.
KW - Abdominal
KW - Aortic aneurysm
KW - Endoleak
KW - Endovascular procedures
UR - http://www.scopus.com/inward/record.url?scp=85101378582&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejvs.2021.01.017
DO - https://doi.org/10.1016/j.ejvs.2021.01.017
M3 - Article
C2 - 33632609
SN - 1078-5884
VL - 61
SP - 779
EP - 786
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 5
ER -