Incidence and Long-Term Implications of Type 2 Endoleak after Endovascular Repair of Abdominal Aortic and Aortoiliac Aneurysms

Type 2 endoleak has been proved not to significantly increase the risk of aneurysm rupture. However, it is associated with aneurysm enlargement and may require secondary interventions. Its role has been widely investigated, but a definitive consensus about its management has still not been obtained. We performed a retrospective, single-center observational study that investigates the incidence of type 2 endoleak and its implications in the long-term follow-up in all the patients who underwent endovascular aortic repair (EVAR) for abdominal aortic aneurysm from 2011 to 2016 at our institution. A total of 216 patients who underwent EVAR during the specified time period were enrolled, and 85 of them (39%) developed type 2 endoleak in their follow-up. Thirty-one of the patients who developed type 2 endoleak faced an aneurysm sac growth > 10 mm and required secondary intervention. Only nine of them showed resolution of the leak. In the long-term follow-up, patients who developed type 2 endoleak after EVAR did not show a significantly increased mortality compared with those who did not, but some of them required late open conversion due to aneurysm sac enlargement and some other developed a secondary type 1 endoleak which required correction. The management of type 2 endoleak remains debated, despite consensus exist regarding the need for intervention when a > 10-mm aneurysm sac growth is observed. Further studies are necessary to better define which are the "high-risk" type 2 endoleaks and identify the patients who would benefit more from correction.