The Analysis And Treatment Of Endoleaks After Endovascular Aneurysm Repair For Abdominal Aortic Aneurysm

Objective: To analyse the mechanism of type I-V endoleaks after endovascular aneurysm repair for abdominal aortic aneurysm, and further discuss the prevention and treatment approaches.Methods: Between January 2011 and December 2015,total 77 patients with infrarenal abdominal aortic aneurysm were treated with endovascular aortic repair(EVAR) in Fujian Medical University Affiliated the Union Hospital. Patients were followed up to evaluate the early and mid term complications,especially the endoleaks.Results: ALL the 77 cases were confirmed by CTA before EVAR. Aneurysm sac ruptures were occurred in four cases and were given emergenct EVAR. Others were given elective EVAR. Perioperative mortality rate was 2.6%(2 out of 77).Other 75 cases of EVAR were performed successfully. The patient was followed up in period range from 1 month to 39 months. 2 cases of lower extremity arterial embolization, 1 case of the left iliac artery stent thrombosis, 1 case of cardiac and renal function insufficiency and 18 cases of post-implantation syndrome occurred.The diameter of the AAA showed significant shrink(5.82±1.62 vs 5.36±1.58,P<0.05).Ten cases of endoleaks developed after EVAR,with reintervention rate of 2.6%, aneurysm sac rupture rate of 0%. Four experienced Ia endoleak which were disappeared during follow up. One case of type Ib endoleak was observed and treated by coil embolism. The persistent blood flow of the branch vessels were observed in two cases of type II endoleak without the enlargement of aneurysm sac. One case of type III endoleak was observed and cured by applying a new graft. One case of type IV was observed with the stable aneurysm sac. One case of type V endoleak were followed up for a long time with slight increase in the aneurysm sac in diameter.Conclusion: Endoleaks are one of the most frequent complications after EVAR and the most common cause of rupture after EVAR. The occurence of Type I endoleak was associated with the length of the aneurysm neck and the angle of the body of it, Type I endoleaks with small amount of blood flow into the sac can be followed up. The endoleaks can be sealed spontaneousely by the thrombolism. However,Type I endoleak with large amount of blood flow into the sac requires urgent intervention. whereas intervention for type II?IV endoleaks or endotension is indicated if the aneurysm sac continues to grow during follow-up. Type III endoleaks was usually linked to the seperation between the graft components, and shoud be treated as soon as possible in case of the aneurysm rupture. The majority of endoleaks can be treated with intervention techniques.