Noticias

Noticias

  • Título: Conservative Management of Some Type-IA EVAR Endoleaks Appears Feasible and Likely Reasonable
  • Fecha: 03-04-2014

  • Presenting at the annual meeting of the European Society for Vascular Surgery (ESVS) last November, Federico Bastos Gonçalves (Utrecht University Medical Center, Utrecht, The Netherlands) recognized that additional therapy is advised if a type IA endoleak is detected on completion angiography during an EVAR procedure. However, he added that there are limitations to the “on-table” correction techniques. For example, a proximal cuff “would be useless if deployment was correct,” and the use of a hand-mounted balloon-expandable stent was limited by diameter and anatomy. Furthermore, conversion to open surgery was associated with 20% to 40% mortality and essentially unthinkable for most patients. He remarked: “We aimed to analyze the results of a conservative strategy for selected patients with primary type IA endoleaks.”

    Between August 2004 and December 2008, 383 patients undergoing EVAR at the Utrecht University Medical Center were prospectively included in an institutional database. All patients had suitable anatomy, received stent graft oversizing of 10% to 20%, and had device deployment at the optimal position. Information on baseline anatomy, intraoperative findings, and follow-up information were included in the database. Fifteen patients had a type IA endoleak (detected intraoperatively). One patient suffered a ruptured aneurysm 2 days after the EVAR, but 53% of the remaining patients did not have evidence of the endoleak on the postoperative CT angiogram 1 week after EVAR. By 5 months, all endoleaks had sealed spontaneously and there were no recurrences during the median follow-up of 27 months. However, by 5 years, 1 patient had a recurrence, 2 patients had been converted to open surgery, 1 patient was converted to AUI, and 2 patients received a proximal cuff. There were no late aneurysm-related deaths.

    Bastos Gonçalves summarized their findings in this manner: “The take-home message is that if the anatomy is suitable for EVAR, the sizing is done correctly, and the stent graft is deployed at the optimal position, most primary type IA endoleaks will seal spontaneously.” However, the risk of rupture persists until the sealing occurs. He concluded that a conservative approach to primary type IA endoleaks may be justified in a selected subgroup at the possible cost of more complications during follow-up.



  • Fuente: endovascular.es