A Multicentre Experience of Inner-Branched Endovascular Aneurysm Repair for Treatment of Type Ia Endoleak After EVAR

PURPOSE: To evaluate the outcomes of inner-branched endovascular aneurysm repair (iBEVAR) for the treatment of type Ia endoleak after infrarenal endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: This multicentre study retrospectively analyzed all consecutive patients who underwent elective revision using iBEVAR for type Ia endoleak after previous infrarenal EVAR. The primary outcome was technical success, and the secondary outcome was clinical success at 30 days. Outcomes during further follow-up were mortality from aneurysm-related causes, type I and III endoleaks, target vessel instability, and aneurysm- or graft-related reinterventions. RESULTS: A total of 20 patients were included in the study; 17 patients were male, and the mean age was 75.2 years (SD 1.7 years). The mean time between initial EVAR and iBEVAR was 6.75 years (SD 0.9 years). Technical success was noted in 95% of cases, as 1 patient died from bleeding sustained during the procedure. Clinical success at 30 days was achieved in 80% of cases. During a median follow-up of 12.0 months (interquartile range [IQR] 1.75-25.0), 6 (30.0%) reinterventions were performed for aortic-related causes. Overall median time to reintervention was 11.0 months (IQR 4.5-11.5). Primary target vessel patency during follow-up was 96.2%. CONCLUSION: Treatment of type Ia endoleak after previous infrarenal EVAR using proximal extension with iBEVAR is technically feasible, yet associated with high morbidity in a fragile patient population. The technique has demonstrated good technical success and high target vessel patency in this short-term analysis. Future research should focus on long-term outcomes and careful patient selection.Clinical ImpactType Ia endoleak is clinically challenging, as treatment using open conversion is associated with high morbidity and mortality. Endovascular methods have been proposed, however often have limitations in applicability and effectiveness. The new iBEVAR cuff has been demonstrated to be effective and applicable in a wide range of anatomical characteristics. The treatment is safe and allows a larger patient population with type Ia endoleak to be treated.