March 3, 2026

Prognostic impact of early type II endoleak detected 1 month after endovascular aneurysm repair on midterm outcomes in a two-center cohort

Key Points

Early type II endoleak is linked to poorer midterm outcomes after endovascular aneurysm repair, indicating its prognostic significance.
A notable percentage, specifically 30%, of patients with early type II endoleak experienced complications within two years.

Structured PICO

Does early type II endoleak detected 1 month after EVAR predict aneurysm sac expansion in patients with degenerative large fusiform abdominal aortic aneurysms?

Population

292 patients with a degenerative large fusiform abdominal aortic aneurysm who underwent endovascular aneurysm repair (EVAR). Excluded: main indication iliac aneurysm, non-degenerative or ruptured aneurysms, without 1-month imaging or with type I/III endoleak.

Intervention

Presence of Type II endoleak (T2EL) detected at 1-month post-EVAR

Comparator

Absence of Type II endoleak (T2EL) at 1-month post-EVAR

Outcome

Aneurysm sac expansion (≥5 mm increase)surrogate

Early type II endoleak detected 1 month after EVAR is a strong predictor of midterm aneurysm sac expansion and the need for reintervention, warranting close surveillance.

Abstract

OBJECTIVE Type II endoleak (T2EL) is the most common complication after endovascular aneurysm repair (EVAR). It is typically considered benign because of frequent spontaneous resolution. However, limited evidence exists on whether early T2EL, detected at 1-month post-EVAR, can reliably predict adverse aortic outcomes during follow-up. METHODS Between January 2009 and December 2024, 444 patients underwent EVAR for aortoiliac aneurysms at two centers. Patients whose main indication was iliac aneurysm, those with non-degenerative or ruptured aneurysms, and those without 1-month imaging or with type I/III endoleak at that time were excluded. The final cohort comprised 292 patients with a degenerative large fusiform abdominal aortic aneurysm. The patients were categorized into T2EL and non-T2EL groups based on 1-month imaging findings. The primary outcome was aneurysm sac expansion (≥5 mm increase); the secondary outcomes were endoleak-related reintervention, open conversion, and all-cause mortality. RESULTS Of the 292 patients, 65 (22.3%) had T2EL and 227 did not at 1-month post-EVAR. The median follow-up durations were 31.1 and 25.3 months in the T2EL and non-T2EL groups, respectively (P=0.475). Sac expansion occurred in 21 (32.3%) and 16 (7.0%) of the patients in the T2EL and non-T2EL groups, respectively (P<0.001). Endoleak-related reintervention was performed in 12 (18.5%) patients with T2EL and 9 (4.0%) without T2EL (P<0.001). All-cause mortality occurred in 19 (29.2%) patients with T2EL and 68 (30.0%) without T2EL (P=0.282). In multivariable analysis, T2EL at 1 month was independently linked to sac expansion (hazard ratio HR, 4.75; 95% confidence interval CI, 2.09-10.78; P<0.001) and endoleak-related reintervention (HR, 3.08; 95% CI, 1.10-8.61; P=0.032). CONCLUSION Early T2EL identified at 1-month post-EVAR was significantly related to sac expansion and endoleak-related reintervention during follow-up. Although it was not associated with the increased all-cause mortality, its presence should be closely monitored. These findings supported the prognostic value of T2EL at 1 month in predicting adverse aortic outcomes after EVAR.

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