Incidence, etiology, and management of type III endoleak after endovascular aortic repair

Abstract

Objective: The objective of this study was to retrospectively assess the incidence, etiology, and management of type III endoleaks in a large cohort of patients treated with endovascular aneurysm repair (EVAR) in two European university centers. Methods: From 1995 until 2014, 965 EVAR procedures were performed with use of first-and second-generation (n = 79) or third-generation (n = 886) endografts. Radiologic follow-up was performed with computed tomography and abdominal plain film examinations in accordance with the European Collaborators on Stent/graft Techniques for aortic Aneurysm Repair (EUROSTAR) scheme. The potential relationship between the type of endograft and the incidence of type III endoleak and the time interval between initial EVAR and diagnosis of type III endoleak were calculated. Results: Twenty patients (2.1%) were identified with 25 type III endoleaks (n = 10/79 [12.7%] for first-and second-generation endografts and n = 10/886 [1.2%] for third-generation endografts; P < .001). Disconnection was found in 14 of 25 endoleaks (56%) and a fabric defect in 11 of 25 (44%) endoleaks, both without any difference between first-and second-vs third-generation endografts (P = .216). The time interval between initial EVAR and type III endoleak was 3.87 and 5.92 years, respectively, for first-or second-generation and third-generation endografts (P = .148). Twenty-five type III endoleaks were treated using endovascular techniques (n = 22 [88%]) or by open surgical conversion (n = 3 [12%]). Conclusions: Type III endoleak rarely (2.1%) occurs after EVAR, with a higher incidence in first-and second-generation endografts. In the majority of cases, the underlying mechanism is disconnection of the stent graft components. Type III endoleaks may occur early or late after initial EVAR and can, in most cases, be managed endovascularly, although type III endoleak may recur.