Outcomes of endovascular treatment of endoleak type Ia after EVAR: a systematic review of the literature

TY - JOUR

T1 - Outcomes of endovascular treatment of endoleak type Ia after EVAR: a systematic review of the literature

AU - Spanos, Konstantinos

AU - Rohlffs, Fiona

AU - Panuccio, Giuseppe

AU - Eleshra, Ahmed

AU - Tsilimparis, Nikolaos

AU - Kölbel, Tilo

PY - 2019/4

Y1 - 2019/4

N2 - INTRODUCTION: Endovascular repair of infra-renal aortic aneurysm (EVAR) has become treatment of choice. However, individuals undergoing EVAR have a high re-intervention rate. The aim of this study is to evaluate the current endovascular treatment modalities of endoleak type Ia (ET Ia) treatment after EVAR and their outcome.EVIDENCE ACQUISITION: A systematic review and meta-analysis was performed. MEDLINE, EMBASE and Cochrane databases were searched with PRISMA methodology for studies reporting on endovascular treatment of ET Ia after EVAR. Studies presenting treatment of intra-operative ET Ia were excluded.EVIDENCE SYNTHESIS: Two international registries, fourteen non-randomized retrospective and twelve case-report studies were included reporting on 356 patients. Reported endovascular techniques included fenestrated-, branched-, chimney EVAR, endovascular sealing (EVAS), endoanchors, embolization techniques, cuff and/or "giant" Palmaz stents. Technical success rate ranged from 90% to 100%, with intra-operative mortality rate of 0%. During early period, persistence of ET Ia was 3.4% (9/262) and the re-intervention rate was 3.5% (8/227). The 30-day mortality rate was 2% (7/356). Mean follow-up was 22.4 months±18. Presence of ET Ia was 5.9% (21/356), and the reintervention rate was 5.1% (18/349). The mortality rate was 13% (26/203), while the primary patency rate of TVs ranged from 94.3% to 100%.CONCLUSIONS: A multitude of techniques for endovascular repair for ET Ia exists. No strong evidence supports one specific technique. The early and mid-term outcomes are encouraging in terms of ET Ia resolution, mortality and morbidity rates.

AB - INTRODUCTION: Endovascular repair of infra-renal aortic aneurysm (EVAR) has become treatment of choice. However, individuals undergoing EVAR have a high re-intervention rate. The aim of this study is to evaluate the current endovascular treatment modalities of endoleak type Ia (ET Ia) treatment after EVAR and their outcome.EVIDENCE ACQUISITION: A systematic review and meta-analysis was performed. MEDLINE, EMBASE and Cochrane databases were searched with PRISMA methodology for studies reporting on endovascular treatment of ET Ia after EVAR. Studies presenting treatment of intra-operative ET Ia were excluded.EVIDENCE SYNTHESIS: Two international registries, fourteen non-randomized retrospective and twelve case-report studies were included reporting on 356 patients. Reported endovascular techniques included fenestrated-, branched-, chimney EVAR, endovascular sealing (EVAS), endoanchors, embolization techniques, cuff and/or "giant" Palmaz stents. Technical success rate ranged from 90% to 100%, with intra-operative mortality rate of 0%. During early period, persistence of ET Ia was 3.4% (9/262) and the re-intervention rate was 3.5% (8/227). The 30-day mortality rate was 2% (7/356). Mean follow-up was 22.4 months±18. Presence of ET Ia was 5.9% (21/356), and the reintervention rate was 5.1% (18/349). The mortality rate was 13% (26/203), while the primary patency rate of TVs ranged from 94.3% to 100%.CONCLUSIONS: A multitude of techniques for endovascular repair for ET Ia exists. No strong evidence supports one specific technique. The early and mid-term outcomes are encouraging in terms of ET Ia resolution, mortality and morbidity rates.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Aneurysm, Abdominal/diagnosis

KW - Aortography/methods

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Computed Tomography Angiography

KW - Endoleak/diagnostic imaging

KW - Endovascular Procedures/adverse effects

KW - Female

KW - Humans

KW - Male

KW - Reoperation

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Patency

U2 - 10.23736/S0021-9509.19.10854-3

DO - 10.23736/S0021-9509.19.10854-3

M3 - SCORING: Journal article

C2 - 30650961

VL - 60

SP - 175

EP - 185

JO - J CARDIOVASC SURG

JF - J CARDIOVASC SURG

SN - 0021-9509

IS - 2

ER -