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Chun JY, de Haan M, Maleux G, Osman A, Cannavale A, Morgan R. CIRSE Standards of Practice on Management of Endoleaks Following Endovascular Aneurysm Repair. Cardiovasc Intervent Radiol 2024; 47:161-176. [PMID: 38216742 PMCID: PMC10844414 DOI: 10.1007/s00270-023-03629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/19/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Endoleaks represent the most common complication after EVAR. Some types are associated with ongoing risk of aneurysm rupture and necessitate long-term surveillance and secondary interventions. PURPOSE This document, as with all CIRSE Standards of Practice documents, will recommend a reasonable approach to best practices of managing endoleaks. This will include imaging diagnosis, surveillance, indications for intervention, endovascular treatments and their outcomes. Our purpose is to provide recommendations based on up-to-date evidence, updating the guidelines previously published on this topic in 2013. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of clinicians with internationally recognised expertise in endoleak management. The writing group reviewed the existing literature performing a pragmatic evidence search using PubMed to select publications in English and relating to human subjects up to 2023. The final recommendations were formulated through consensus. RESULTS Endoleaks may compromise durability of the aortic repair, and long-term imaging surveillance is necessary for early detection and correct classification to guide potential re-intervention. The majority of endoleaks that require treatment can be managed using endovascular techniques. This Standards of Practice document provides up-to-date recommendations for the safe management of endoleaks.
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Affiliation(s)
- Joo-Young Chun
- St George's University Hospitals NHS Foundation Trust, London, UK.
- St George's University of London, London, UK.
| | - Michiel de Haan
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Asaad Osman
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Robert Morgan
- St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
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Sun Y, Cai HB, Yang D, Li WY, Zhao W, Hu JH, Li M, Peng MS, Yuan F, Qing KX. Volumetric analysis of effectiveness of embolization for preventing type II endoleaks following endovascular aortic aneurysm repair. J Vasc Surg 2023; 77:752-759.e2. [PMID: 36441022 DOI: 10.1016/j.jvs.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The presence of endoleak was associated with the failure of endovascular aortic aneurysm repair (EVAR) treatment. The key to eliminating type II endoleak has shifted from reintervention to prevention. This study aimed to evaluate the effectiveness and safety of applying fibrin sealant to prevent type II endoleak in conjunction with EVAR. METHODS All patients with abdominal aortic aneurysm who underwent EVAR from June 2019 to July 2021 were reviewed. Patients were grouped as Group A: standard EVAR with preemptive embolization and Group B: standard EVAR alone. The primary endpoint was the incidence of type II endoleak. The secondary endpoints were aneurysm sac regression, the inferior mesenteric artery patency, the numbers of patent lumbar arteries, and all-cause mortality. RESULTS A total of 104 patients were included in Group A, and 116 were included in Group B. Technical success rate was 100%. The overall incidence of type II endoleak in Group A was significantly lower than that in Group B (4.8% vs 19.0%). The mean time of freedom from type II endoleak was 22.71 months for Group A (95% confidence interval, 21.59-23.83 months) and 19.89 months for Group B (95% confidence interval, 18.08-21.70 months). The Kaplan-Meier estimate of freedom from type II endoleak showed a significantly longer duration of freedom from type II endoleak in Group A (81.0% vs 95.2%). Group A showed a continuous sac regression tendency. In Group B, the sac volume decreased within 12 months but increased by 3.07 cm3 at 24 months. No complications were noted in both groups. CONCLUSIONS Nonselective preemptive embolization with porcine fibrin sealant during EVAR was safe and effective in preventing type II endoleak in the short and mid-term. Preemptive embolization can lead to a significantly higher sac regression rate. Larger patient populations and longer follow-ups with randomized control designed trials are expected to verify the long-term effectiveness and safety of preemptive embolization in preventing type II endoleak.
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Affiliation(s)
- Yuan Sun
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Hong-Bo Cai
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Di Yang
- The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Wei-Yi Li
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Wei Zhao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Ji-Hong Hu
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Min Li
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Ming-Sheng Peng
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Feng Yuan
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Kai-Xiong Qing
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, People's Republic of China.
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Chun JY, Morgan R. Ischaemic Sequelae Following Glue Embolization of Type 2 Endoleak Involving Multiple Lumbar Arteries. Cardiovasc Intervent Radiol 2020; 43:1406-1408. [DOI: 10.1007/s00270-020-02581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
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Transabdominal Direct Sac Puncture Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Interv Radiol 2018; 29:1167-1173. [DOI: 10.1016/j.jvir.2018.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
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Follow up CT angiography post EVAR: Endoleaks detection, classification and management planning. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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