The natural history of type 2 endoleaks after endovascular aneurysm repair justifies conservative management

Objective Management of type 2 endoleaks after endovascular aneurysm repair has been controversial. Some advocate for conservative management, while others believe that intervention is indicated. This study investigated the natural history of type 2 endoleaks in order to derive direction in management. Methods Patients who had endovascular aneurysm repair at the Veterans Affairs Long Beach were retrospectively identified and computerized tomographic angiography was independently reviewed by a radiologist and a vascular surgeon. Type 2 endoleaks were analyzed for the following outcomes: rupture, duration of endoleak, spontaneous resolution, changes in the size of the aneurysm sac, and reintervention rates. Results Of the 160 patients who had completed required follow-up to date (mean 3 years) after endovascular aneurysm repair, 39 (24.4%) patients were identified as having a type 2 endoleak on computerized tomographic angiography imaging. 6 (15.4%) of these 39 patients required repair due to aneurysm sac growth >1 cm. 2 (5.13%) were repaired with an open procedure and 4 (10.3%) with an endovascular approach. Of these 6 aneurysm leaks requiring repair, 4 (66.7%) had a simultaneous endoleak (types 1 or 3) in addition to the identified type 2 endoleak. Spontaneous resolution of type 2 endoleaks occurred in 16 (41.0%) patients. 4 patients (10.3%) had delayed type 2 endoleaks that presented 4, 9, 12, and 23 months after their 30 day post op computed tomography was normal. None of the 4 patients with delayed type 2 endoleaks required reintervention and none had aneurysm sac growth greater than 5 mm. Conclusions Overall, we found that 85% of patients who had type 2 endoleaks did not require intervention after a mean follow-up time of 3 years. The association of a type 1 or 3 endoleak with a type 2 endoleak was more likely to require correction due to aneurysm expansion >1 cm, thus type 2 endoleaks associated with another type of endoleak require more aggressive management.

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Type 2 Endoleak Management

Seminars in Interventional Radiology ◽

10.1055/s-0040-1715873 ◽

2020 ◽

Vol 37 (04) ◽

pp. 365-370

Author(s):

James X. Chen ◽

S. William Stavropoulos

Keyword(s):

Natural History ◽

Endovascular Aneurysm Repair ◽

Treatment Strategies ◽

Current Treatment ◽

Type 2 Endoleak ◽

History Of ◽

Aneurysm Repair

AbstractType 2 endoleaks are the most common endoleak type following endovascular aneurysm repair. The natural history of these endoleaks can vary, with some demonstrating a self-limited or indolent course, while others can contribute to aneurysm sac enlargement and rupture. A variety of embolization techniques, including transarterial catheterization and direct sac puncture techniques, have been developed for the treatment of type 2 endoleaks. In this article, the authors review the indications, techniques, and outcomes of current treatment strategies for type 2 endoleaks.

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The spontaneous resolution of a vortex vein varix: case report

BMC Ophthalmology ◽

10.1186/s12886-021-01861-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sara L Weidmayer ◽

Hakan Demirci

Keyword(s):

Case Report ◽

Natural History ◽

Extended Period ◽

Spontaneous Resolution ◽

Case Presentation ◽

Clinical Resolution ◽

History Of ◽

Vortex Vein ◽

Insight Into

Abstract Background The natural course of a vortex vein varix, though not well understood, has been known to remain stable. However, here we report a novel case of a vortex vein varix that resolved after an extended period of monitoring. Case presentation An asymptomatic 96-year-old Caucasian man was found to have a vortex vein varix. At his previous examination 13 months prior, his fundus was normal. At 13 months of observation, his vortex vein varix become clinically undetectable. Further follow-up confirmed continued absence of the varix. Conclusion This case demonstrates the development then clinical resolution of a vortex vein varix with no clear identifiable factors for its evolution. This case is novel and offers new insight into the natural history of some vortex vein varices, implicating venous congestion as an instigator and venous collateralization as its alleviator, suggesting that vortex vein varices are likely more common than previously reported since some may be temporary and under-identified.

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Type 2 Endoleak With or Without Intervention and Survival After Endovascular Aneurysm Repair

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2021.01.017 ◽

2021 ◽

Cited By ~ 1

Author(s):

Sana Mulay ◽

Anna C.M. Geraedts ◽

Mark J.W. Koelemay ◽

Ron Balm ◽

Sana Mulay ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Type 2 Endoleak ◽

Aneurysm Repair

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Real-World Experience with Type I Endoleaks after Endovascular Repair of the Thoracic Aorta

The American Surgeon ◽

10.1177/000313481007600623 ◽

2010 ◽

Vol 76 (6) ◽

pp. 599-605 ◽

Cited By ~ 4

Author(s):

Joshua D. Adams ◽

Margaret C. Tracci ◽

Sahir Sabri ◽

Kenneth J. Cherry ◽

John F. Angle ◽

...

Keyword(s):

Natural History ◽

Thoracic Endovascular Aortic Repair ◽

Spontaneous Resolution ◽

Type I ◽

Single Center ◽

Type I Endoleak ◽

History Of ◽

Aortic Pathologies ◽

Initial Results

Endoleaks are a frequent complication of thoracic endovascular aortic repair (TEVAR) and will likely increase in incidence with application of the technique to more complicated aortic anatomy and a wider range of thoracic aortic pathologies. Management generally consists of aggressive repair of Type I endoleaks; however, the natural history of Type I endoleaks after TEVAR remains largely unknown. The purpose of this study was to examine the incidence and characteristics of Type I endoleaks and to evaluate clinical outcomes of patients with Type I endoleaks after TEVAR. A single-center retrospective review was performed on all patients who underwent TEVAR over a 4-year period. Type I endoleaks were detected in 21 per cent (27 of 129) of patients on post-deployment aortography or CT angiography. During a mean follow-up of 750.63 ± 483 days, 59 per cent (16 of 27) closed spontaneously; 30 per cent (eight of 27) required secondary endovascular intervention; and 11 per cent (three of 27) have persisted with no increase in maximum aortic diameter. No patients have died or required open surgical conversion as a result of their Type I endoleak. Although accurate predictors of spontaneous resolution of Type I endoleaks have yet to be definitively characterized, our initial results suggest that it may be safe to observe small Type I endoleaks given that a large percentage resolve spontaneously and no endoleak-related deaths have occurred.

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Different Contributions of Dyslipidemia and Obesity to the Natural History of Type 2 Diabetes: 3-Year Cohort Study in China

Journal of Diabetes Research ◽

10.1155/2019/4328975 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Lu Liu ◽

Xiaoling Guan ◽

Zhongshang Yuan ◽

Meng Zhao ◽

Qiu Li ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cohort Study ◽

Natural History ◽

Glucose Tolerance ◽

Serum Triglyceride ◽

Glycemic Status ◽

History Of

Aim. It is known that different stages of type 2 diabetes represent distinct pathophysiological changes, but how the spectrum of risk factors varies at different stages is not yet clarified. Hence, the aim of this study was to compare the effect of different metabolic variables on the natural history of type 2 diabetes. Methods. A total of 5,213 nondiabetic (normal glucose tolerance (NGT) and prediabetes) Chinese older than 40 years participated this prospective cohort study, and 4,577 completed the 3-year follow-up. Glycemic status was determined by standard oral glucose tolerance test both at enrollment and follow-up visit. Predictors for conversion in glycemic status were studied in a corresponding subcohort using the multiple logistic regression analysis. Results. The incidence of prediabetes and diabetes of the cohort was 93.6 and 42.2 per 1,000 person-years, respectively. After a 3-year follow-up, 33.1% of prediabetes patients regressed to NGT. The predictive weight of body mass index (BMI), serum triglyceride, total cholesterol, and systolic blood pressure in different paths of conversions among diabetes, prediabetes, and NGT differed. Specifically, BMI was the strongest predictor for regression from prediabetes to NGT, while triglyceride was most prominent for onset of diabetes. One SD increase in serum triglyceride was associated with a 1.29- (95% CI 1.10–1.52; P=0.002) or 1.12- (95% CI 1.01–1.27; P=0.039) fold higher risk of diabetes for individuals with NGT or prediabetes, respectively. Conclusion. Risk factors for different stages of diabetes differed, suggesting personalized preventive strategies for individuals with different basal glycemic statuses.

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Aortocaval fistula, a potentially favourable complication of abdominal aortic aneurysm rupture in endovascular repair

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0090 ◽

2020 ◽

Vol 102 (8) ◽

pp. e180-e182 ◽

Cited By ~ 1

Author(s):

S Greenfield ◽

G Martin ◽

M Malina ◽

NS Theivacumar

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Unexpected Finding ◽

Ruptured Abdominal Aortic Aneurysm ◽

Aortocaval Fistula ◽

Abdominal Aortic ◽

Type 2 Endoleak ◽

Aneurysm Repair

Endovascular aneurysm repair is an established treatment for ruptured abdominal aortic aneurysm. Primary aortocaval fistula is an exceedingly rare finding in ruptured abdominal aortic aneurysm, with a reported incidence of less than 1%. The presence of an aortocaval fistula used to be an unexpected finding in open surgical repair which often resulted in massive haemorrhage and caval injury. We present a case of ruptured abdominal aortic aneurysm with an aortocaval fistula that was successfully treated with percutaneous endovascular aneurysm repair under local anaesthesia. Despite a persistent type 2 endoleak the aneurysm sack shrank from 8.4cm to 4.8cm in 12 months. The presence of an aortocaval fistula may have depressurised the aneurysm, resulting in less bleeding retroperitoneally and may have promoted rapid shrinkage of the sac despite the presence of a persistent type 2 endoleak.

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Early Computed Tomographic Angiography after Endovascular Aneurysm Repair: Worthwhile or Worthless?

Vascular ◽

10.2310/6670.2008.00034 ◽

2008 ◽

Vol 16 (5) ◽

pp. 253-257 ◽

Cited By ~ 6

Author(s):

Evert J. Waasdorp ◽

Joost A. van Herwaarden ◽

Rob H.W. van de Mortel ◽

Frans L. Moll ◽

Jean-Paul P.M. de Vries

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Computed Tomographic Angiography ◽

Type I ◽

Type Ii ◽

Graft Thrombosis ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Aneurysm Repair

This study evaluated the value of computed tomographic angiography (CTA) early after an endovascular aneurysm repair (EVAR) in relation to CTA 3 months after EVAR. We retrospectively reviewed all elective EVAR patients with available postprocedural and 3-month follow-up CTAs who were treated between 1996 and 2006. CTAs were analyzed for EVAR-related complications in terms of endoleaks, migration, and stent graft thrombosis. Secondary procedures and other complications within a 4-month time interval after EVAR were noted and analyzed for any association with the postprocedural CTA. During the study period, 291 patients (275 men), with a mean age of 71 years, underwent elective EVAR. All had postprocedural and 3-month follow-up CTAs, which detected 93 (32%) endoleaks (8 type I, 84 type II, 1 type III) and 1 stent graft thrombosis. These findings resulted in four secondary interventions (one interposition cuff, two extension cuffs, one conversion). All reinterventions were successfully done in an elective setting. During the first 3 postoperative months, five other reinterventions were required for acute ischemia in four patients (three Fogarty procedures, one femorofemoral crossover bypass) or groin infection in one patient. Eight patients died, but none of the deaths were related to abdominal aortic aneurysm or EVAR (four cardiac, two pulmonary, one gastric bleeding, one carcinoma). At 3 months, 43 endoleaks (3 type I, 40 type II), 3 stent graft thromboses, and 1 stent graft migration were seen. In two patients (0.7%), a new endoleak was diagnosed compared with the postprocedural CTAs. In 287 (99%) of 291 patients, the postprocedural CTA did not influence our treatment policy in the first 3 months after EVAR. More than half of the early endoleaks were self-limiting, and new endoleaks were seen in only two patients (< 1%) at the 3-month follow-up CTA. After an uneventful EVAR procedure, it is safe to leave out the early postprocedural CTA.

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