An inferior mesenteric artery >4 mm independently predicted the need for intervention in patients with type II endoleaks (HR 7.18; 95% CI 1.97-26.16; P<0.01).
Cohort (n=207)
Do large IMA, multiple lumbar arteries, and anticoagulation predict the need for intervention in patients with type II endoleaks after EVAR?
An inferior mesenteric artery >4 mm, >6 lumbar arteries, and anticoagulation use are strong predictors for requiring embolization in patients with type II endoleaks after EVAR.
Effect estimate: HR 7.18 (95% CI 1.97-26.16)
p-value: p=<0.01
Introduction Endovascular abdominal aortic aneurysm repair (EVAR) is the primary treatment for abdominal aortic aneurysm (AAA). Despite favorable early outcomes, lifelong surveillance is essential as endoleaks remain a major cause of reintervention. Among these, type II endoleaks (T2E) remain controversial regarding optimal management. This study aimed to identify factors associated with intervention for T2E using time-to-event analysis and predefined anatomic thresholds. Secondary objectives included comparing outcomes between T2E patients with (intT2E) and without (nointT2E) intervention. Methods A retrospective review of EVAR procedures from 2011-2024 was performed. Patients with newly diagnosed or persistent T2E were identified on completion and follow-up CT angiography. Patients were categorized as intT2E or nointT2E. Multivariable Cox regression evaluated time to first intervention, and logistic regression served as sensitivity analysis. Kaplan-Meier curves assessed freedom from intervention by inferior mesenteric artery (IMA) size. Results Among 207 EVAR patients, 78 (37.6%) developed T2E over a mean 3.4 ± 2.4 years. Nineteen (24.3%) required intervention. IntT2E patients were younger (74.9 ± 6.8 vs 78.3 ± 7.9 years, P = 0.02), had more frequent anticoagulation use (47.4% vs 20.3%, P = 0.02), larger IMAs (4.2 ± 0.6 vs 3.3 ± 0.7 mm, P 4 mm occurred in 68.4% of intT2E vs 8.5% of nointT2E ( P 4 mm independently predicted intervention (HR 7.18, 95% CI 1.97-26.16, P 4 mm (OR 23.4, 95% CI 6.17-88.6, P 6 lumbar arteries (OR 4.2, 95% CI 1.10-15.98, P = 0.02), and anticoagulation (OR 3.4, 95% CI 1.17-10.6, P = 0.02) as predictors. Conclusions Approximately one-quarter of T2E patients required embolization. IMA >4 mm was the strongest predictor of intervention, while anticoagulation and increased lumbar artery number also increased risk. Management should prioritize risk-stratified surveillance and selective intervention.
Vernon et al. (Wed,) conducted a cohort in Type II endoleaks after endovascular abdominal aortic aneurysm repair (n=207). Inferior mesenteric artery (IMA) >4 mm vs. IMA ≤4 mm was evaluated on Time to first intervention for type II endoleak (HR 7.18, 95% CI 1.97-26.16, p=<0.01). An inferior mesenteric artery >4 mm independently predicted the need for intervention in patients with type II endoleaks (HR 7.18; 95% CI 1.97-26.16; P<0.01).