Prevention and treatment of type II endoleaks — a retrospective analysis

Introduction: Endovascular aneurysm repair (EVAR) is a widely adopted method for treating abdominal aortic aneurysms. The most common complication of this procedure is the occurrence of endoleaks, i.e., leakages in the area of the endograft, with type II endoleaks being the most frequently observed. Several strategies exist for both the treatment and prevention of type II endoleaks, including preemptive embolization of aortic side branches within the aneurysmal sac before stent graft implantation. Objective: The aim of the study was to compare the effectiveness of various strategies regarding the prevention and treatment of type II endoleaks following EVAR. Materials and methods: A retrospective comparative cohort study including 186 patients treated with EVAR was carried out. In 11 patients, embolization was performed either before or during the EVAR procedure. In 9 patients, type II endoleaks were managed through transarterial embolization via brachial or femoral artery access. Results: None of the patients who underwent successful embolization before or during EVAR developed endoleaks. In 5 patients, initially qualified for embolization before EVAR, however, embolization proved unsuccessful. Type II endoleaks requiring intervention were diagnosed in 16 patients, with 2 of these cases requiring repeat intervention. Conclusions: EVAR is an effective method for the treatment of abdominal aortic aneurysms. In the event of a type II endoleak following EVAR, embolization may be required, and in some cases, more than one intervention is necessary. Preemptive embolization of aortic side branches within the aneurysmal sac, performed before or during the EVAR procedure, represents a justified management strategy that may help reduce the occurrence of endoleaks.