Experience in Treatment of Patients with First Type Secondary Endoleaks

Abstract

INTRODUCTION: First type secondary endoleaks (EL) require quickest elimination, primarily using the endovascular methods. Despite the existence of a sufficiently large number of methods of their elimination, the results of treatment remain ambiguous.

AIM: Analysis of our own experience of elimination of the first type ELs in patients after endoprosthetics of infrarenal abdominal aortic aneurysm.

MATERIALS AND METHODS: The study is retrospective with prospective observation. All patients underwent computed tomography (CT) for identification of the type of EL and choosing a method of its elimination. The term ‘first type secondary EL’ was understood as EL which developed in the long-term period after the primarily negative CT-angiography after endoprosthetic repair of the aorta.

RESULTS: ELs of Ia type were diagnosed in 14 cases, in one case EL of Ib type was identified. On average, first type secondary ELs were identified in 34 months after the primary operation for endograft implantation. In 2 of 15 patients, EL were symptomatic. The elimination of the first type EL required an individualized approach in all cases. The main methods of elimination of the first type EL were: elongation using Jotec E-iliac (n = 1); coiling with implantation of Gore cuff and Chimney-stenting of the left renal artery (LRA; n = 2); implantation of Gore cuff (n = 4); reinforcement with Aptus EndoAnchors (n = 2); Cuff Gore implantation and LRA stenting by Chimney-technique (n = 1); implantation of Cuff Jotec and reinforcement with Aptus EndoAnchors (n = 1); aneurysmal sac coiling (n = 2); Gore cuff implantation with fixation with EndoAnchors and LRA stenting using Chimney-technique (n = 1). The technical success of EL elimination was 100% (in all cases, the success was confirmed by intraoperative angiography, as well as by CT angiography or ultrasound duplex scanning with contrast enhancement after surgery), there were no deaths. In the long-term period (from 6 to 60 months), re-interventions were performed in two cases, fatal outcome happened in one case, after a late open conversion for elimination of EL.

CONCLUSION: In 13% of cases, first type ELs were symptomatic, and their elimination required individual approach with taking into account anatomical factors and the implanted graft. The medium-term results of the elimination of the first type EL are good, no fatal cases have been reported, and the number of reinterventions has reached 20%, which requires monitoring in the postoperative period.

Keywords

first type endoleaks / re-interventions / abdominal aortic aneurysm / endograft

References

[1] Uryas'yev OM, Zhukova LA, Glotov SI, et al. Difficulties in diagnosing aortic dissection in real clinical practice. Nauka Molodykh (Eruditio Juvenium). 2022;10(1):63–74. (In Russ). doi: 10.23888/HMJ202210163-74

[2] Урясьев О.М., Жукова Л.А., Глотов С.И., и др. Сложности диагностики расслоения аорты в реальной клинической практике // Наука молодых (Eruditio Juvenium). 2022. Т. 10, № 1. С. 63–74. doi: 10.23888/HMJ202210163-74

[3] Kalmykov EL, Suchkov IA, Kalinin RE, et al. The Role and Significance of Polymorphisms of Certain Genes in Patients with Abdominal Aortic Aneurysm. I. P. Pavlov Russian Medical Biological Herald. 2022;30(4):437–45. (In Russ). doi: 10.17816/PAVLOVJ108311

[4] Kalmykov E.L., Сучков И.А., Калинин Р.Е., и др. Роль и значение ряда полиморфизмов генов у пациентов с аневризмой брюшной аорты // Российский медико-биологический вестник имени академика И. П. Павлова. 2022. Т. 30, № 4. С. 437–445. doi: 10.17816/PAVLOVJ108311

[5] Watts MM. Percutaneous Endovascular Aneurysm Repair: Current Status and Future Trends. Semin Intervent Radiol. 2020;37(4):339–45. doi: 10.1055/s-0040-1714728

[6] Watts M.M. Percutaneous Endovascular Aneurysm Repair: Current Status and Future Trends // Semin. Intervent. Radiol. 2020. Vol. 37, No. 4. P. 339–345. doi: 10.1055/s-0040-1714728

[7] Trenner M, Haller B, Storck M, et al. How EVAR Changed the Game: Trends in Patient Characteristics, Surgical Techniques and Outcomes of Non-ruptured AAA Repair in Germany from 1999 to 2010. Eur J Vasc Endovasc Surg. 2015;50(3):402. doi: 10.1016/j.ejvs.2015.06.066

[8] Trenner M., Haller B., Storck M., et al. How EVAR Changed the Game: Trends in Patient Characteristics, Surgical Techniques and Outcomes of Non-ruptured AAA Repair in Germany from 1999 to 2010 // Eur. J. Vasc. Endovasc. Surg. 2015. Vol. 50, No. 3. P. 402. doi: 10.1016/j.ejvs.2015.06.066

[9] Suckow BD, Goodney PP, Columbo JA, et al. National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients. J Vasc Surg. 2018;67(6):1690–7.e1. doi: 10.1016/j.jvs.2017.09.046

[10] Suckow B.D., Goodney P.P., Columbo J.A., et al. National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients // J. Vasc. Surg. 2018. Vol. 67, No. 6. P. 1690.e1–1697.e1. doi: 10.1016/j.jvs.2017.09.046

[11] Nikonenko TN, Nikonenko AA. Morphogenesis abdominal aortic aneurysm. I. P. Pavlov Russian Medical Biological Herald. 2013;(2):7–12. (In Russ).

[12] Никоненко Т.Н., Никоненко А.А. Морфогенез аневризмы брюшного отдела аорты // Российский медико-биологический вестник имени академика И. П. Павлова. 2013. № 2. С. 7–12.

[13] Kalinin RE, Suchkov IA, Karpov VV, et al. History of Use of Homografts in Vascular Surgery (Literature Review). Nauka Molodykh (Eruditio Juvenium). 2022;10(3):335–48. (In Russ). doi: 10.23888/HMJ2022103335-347

[14] Калинин Р.Е., Сучков И.А., Карпов В.В., и др. История применения гомографтов в сосудистой хирургии (литературный обзор) // Наука молодых (Eruditio Juvenium). 2022. Т. 10, № 3. С. 335–348. doi: 10.23888/HMJ2022103335-347

[15] Kalmykov EL, Suchkov IA, Kalinin RE, et al. Endoleaks in endovacular treatment of infrareneral abdominal aortic aneurysm (part I). Pirogov Russian Journal of Surgery. 2022;(7):77–84. (In Russ). doi: 10.17116/hirurgia202207177

[16] Калмыков Е.Л., Сучков И.А., Калинин Р.Е., и др. Эндолики при эндоваскулярном протезировании инфраренальной аневризмы брюшной аорты (часть I) // Хирургия. Журнал им. Н.И. Пирогова. 2022. № 7. С. 77–84. doi: 10.17116/hirurgia202207177

[17] Kalmykov EL, Suchkov IA, Damrau R. Embolization of endoleaks after endovascular abdominal aortic repair. Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2022;15(5):451–55. (In Russ). doi: 10.17116/kardio202215051451

[18] Калмыков Е.Л., Сучков И.А., Даммрау Р. Эмболизация эндоликов при эндоваскулярном протезировании брюшной аорты // Кардиология и сердечно-сосудистая хирургия. 2022. Т. 15, № 5. С. 451–455. doi: 10.17116/kardio202215051451

[19] Patel R, Sweeting MJ, Powell JT, et al. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366–74. doi: 10.1016/S0140-6736(16)31135-7

[20] Patel R., Sweeting M.J., Powell J.T., et al. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial // Lancet. 2016. Vol. 388, No. 10058. P. 2366–2374. doi: 10.1016/S0140-6736(16)31135-7

[21] Wanhainen A, Verzini F, van Herzeele I, et al. Editor's Choice — European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8–93. doi: 10.1016/j.ejvs.2018.09.020

[22] Wanhainen A., Verzini F., van Herzeele I., et al. Editor's Choice — European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms // Eur. J. Vasc. Endovasc. Surg. 2019. Vol. 57, No. 1. P. 8–93. doi: 10.1016/j.ejvs.2018.09.020

[23] Natsional’nyye rekomendatsii po vedeniyu patsiyentov s anevrizmami bryushnoy aorty. Moscow; 2013. Available at: https://www.angiolsurgery.org/recommendations/2013/recommendations_AAA.pdf. Accessed: 2023 September 12. (In Russ).

[24] Национальные рекомендации по ведению пациентов с аневризмами брюшной аорты. М.; 2013. Доступно по: https://www.angiolsurgery.org/recommendations/2013/recommendations_AAA.pdf. Ссылка активна на 12.09.2023.

[25] Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2–77.e2. doi: 10.1016/j.jvs.2017.10.044

[26] Chaikof E.L., Dalman R.L., Eskandari M.K., et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm // J. Vasc. Surg. 2018. Vol. 67, No. 1. P. 2.e2–77.e2. doi: 10.1016/j.jvs.2017.10.044

[27] Kalmykov EL, Sadriev ON. Late conversions after endovascular abdominal aortic repair. Angiology and Vascular Surgery. 2016;22(3):168–75. (In Russ).

[28] Калмыков Е.Л., Садриев О.Н. Поздние конверсии после эндопротезирования аневризм брюшной аорты // Ангиология и сосудистая хирургия. 2016. Т. 22, № 3. С. 168–175.

[29] Kouvelos G, Koutsoumpelis A, Lazaris A, et al. Late open conversion after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2015;61(5):1350–6. doi: 10.1016/j.jvs.2015.02.019

[30] Kouvelos G., Koutsoumpelis A., Lazaris A., et al. Late open conversion after endovascular abdominal aortic aneurysm repair // J. Vasc. Surg. 2015. Vol. 61, No 5. P. 1350–1356. doi: 10.1016/j.jvs.2015.02.019

[31] Perini P, Gargiulo M, Silingardi R, et al. Multicenter comparison between open conversions and semi-conversions for late endoleaks after endovascular aneurysm repair. J Vasc Surg. 2022;76(1):104–12. doi: 10.1016/j.jvs.2022.01.023

[32] Perini P., Gargiulo M., Silingardi R., et al. Multicenter comparison between open conversions and semi-conversions for late endoleaks after endovascular aneurysm repair // J. Vasc. Surg. 2022. Vol. 76, No. 1. P. 104–112. doi: 10.1016/j.jvs.2022.01.023

[33] Cao P, De Rango P, Verzini F, et al. Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair. J Cardiovasc Surg (Torino). 2010;51(1):53–69.

[34] Cao P., De Rango P., Verzini F., et al. Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair // J. Cardiovasc. Surg. (Torino). 2010. Vol. 51, No. 1. P. 53–69.

[35] Chen J, Stavropoulos SW. Management of Endoleaks. Semin Intervent Radiol. 2015;32(3):259–64. doi: 10.1055/s-0035-1556825

[36] Chen J., Stavropoulos S.W. Management of Endoleaks // Semin. Intervent. Radiol. 2015. Vol. 32, No. 3. P. 259–264. doi: 10.1055/s-0035-1556825

[37] Buijs RVC, Zeebregts CJ, Willems TP, et al. Endograft Sizing for Endovascular Aortic Repair and Incidence of Endoleak Type 1A. PLoS One. 2016;11(6):e0158042. doi: 10.1371/journal.pone.0158042

[38] Buijs R.V.C., Zeebregts C.J., Willems T.P., et al. Endograft Sizing for Endovascular Aortic Repair and Incidence of Endoleak Type 1A // PLoS One. 2016. Vol. 11, No. 6. P. e0158042. doi: 10.1371/journal.pone.0158042

[39] Tashima Y, Tamai K, Shirasugi T, et al. Successful Aortic Banding for Type IA Endoleak Due to Neck Dilatation after Endovascular Abdominal Aortic Aneurysm Repair: Case Report. Ann Vasc Dis. 2017;10(3):265–9. doi: 10.3400/avd.cr.17-00007

[40] Tashima Y., Tamai K., Shirasugi T., et al. Successful Aortic Banding for Type IA Endoleak Due to Neck Dilatation after Endovascular Abdominal Aortic Aneurysm Repair: Case Report // Ann. Vasc. Dis. 2017. Vol. 10, No. 3. P. 265–269. doi: 10.3400/avd.cr.17-00007

[41] Rajani RR, Arthurs ZM, Srivastava SD, et al. Repairing immediate proximal endoleaks during abdominal aortic aneurysm repair. J Vasc Surg. 2011;53(5):1174–7. doi: 10.1016/j.jvs.2010.11.095

[42] Rajani R.R., Arthurs Z.M., Srivastava S.D., et al. Repairing immediate proximal endoleaks during abdominal aortic aneurysm repair // J. Vasc. Surg. 2011. Vol. 53, No. 5. P. 1174–1177. doi: 10.1016/j.jvs.2010.11.095

[43] Ameli–Renani S, Pavlidis V, Morgan RA. Secondary Endoleak Management Following TEVAR and EVAR. Cardiovasc Intervent Radiol. 2020;43(12):1839–54. doi: 10.1007/s00270-020-02572-9

[44] Ameli–Renani S., Pavlidis V., Morgan R.A. Secondary Endoleak Management Following TEVAR and EVAR // Cardiovasc. Intervent. Radiol. 2020. Vol. 43, No. 12. P. 1839–1854. doi: 10.1007/s00270-020-02572-9

[45] Perini P, Massoni CB, Mariani E, et al. Systematic Review and Meta-Analysis of the Outcome of Different Treatments for Type 1a Endoleak After EVAR. Ann Vasc Surg. 2019;60:435–46.e1. doi: 10.1016/j.avsg.2019.03.032

[46] Perini P., Massoni C.B., Mariani E., et al. Systematic Review and Meta-Analysis of the Outcome of Different Treatments for Type 1a Endoleak After EVAR // Ann. Vasc. Surg. 2019. Vol. 60. P. 435.e1–446.e1. doi: 10.1016/j.avsg.2019.03.032

[47] Van Slambrouck J, Mufty H, Maleux G, et al. The impact of type 1a endoleak on the long-term outcome after EVAR. Acta Chir Belg. 2021;121(5):333–9. doi: 10.1080/00015458.2020.1794337

[48] Van Slambrouck J., Mufty H., Maleux G., et al. The impact of type 1a endoleak on the long-term outcome after EVAR // Acta Chir. Belg. 2021. Vol. 121, No. 5. P. 333–339. doi: 10.1080/00015458.2020.1794337

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