Multisciplinary Management Of Endoleaks After Endovascular Aneurysm Repair By Creation Of The Endoleak Team

The presence of any kind of endoleak (EL) can jeopardize the durability of endovascular aneurysm repair (EVAR). The aim of this study was to evaluate the role of an EL Team in the management of EL after EVAR. Patients with any type I ELs or type II ELs with sac expansion >1 cm were included in this single-center, retrospective study. A multidisciplinary team (EL Team) involving vascular surgeons and interventional radiologists was set up for the management of EL in 2015. Before 2015, only vascular surgeons were involved in the EL treatment. Technical success, mortality, occurrence of complications, surgical conversion rate, and sac expansion were analyzed at 2-year follow-up. Two groups were created: group A for EL treated by vascular surgeons between 2011 and 2014 and group B for EL treated after 2015. Seventy ELs were included: 37 ELs were in group A (21 type II, 16 type I) and 33 ELs in group B (19 type II, 14 type I). In the Table are listed the types of reinterventions performed. Of note, a nonoperative approach was only performed in group A in 11 (53%) type II ELs, and the use of coil embolization as the method of treatment was significantly more applied in group B. All ELs in group B received an intervention. During the 2-year follow-up period, one aneurysm-related death occurred in both groups due to rupture (group A: 2.7%; group B: 3%; P = 1), and two other adjunctive non-aneurysm-related deaths occurred in both groups (P = 1). Technical success was 80.8% vs 100% (P = .013) for groups A and B, respectively. Group B presented a lower probability of developing a sac expansion (P = .002, odds ratio = 0.137, NegelkerkeR2 = 0.30). As illustrated by the Kaplan-Meier curves, group B had a significantly lower rate of sac expansion compared with group A (log rank = 0.001). Freedom from sac expansion at 12, 18, and 24 months was 69.4%, 63.9%, and 33.3%, and 93.9%, 90.7%, and 78.8% for groups A and B, respectively. No major complications were reported in group B, whereas only one case of graft migration requiring surgical conversion was described in group A; minor periprocedural complications were reported in both groups without significant differences (group A vs group B: 3% vs 2.7%; P = 1.000). At 2-year follow-up, 4 (10.8%) patients were converted in group A, whereas none in group B (P = .11). The introduction of an EL Team in the clinical practice of a vascular center is safe and makes it possible to treat type II ELs more effectively, promoting technical success and reducing the probability of sac expansion at 2-year follow-up. More data and long-term follow-up are required to confirm our findings.TableTypes of reinterventionsGroup AN = 37Group BN = 33P valueType I endoleaks,N (%)16 (43)14 (42) Treated by coil embolization3 (19)9 (64).02 Treated by cuff13 (81)(2 chimneys)5 (36).02Type II endoleaks, N (%)21 (57)19 (52) Conservative management11 (53)0 (0)