ENDOLEAK EVALUATION AFTER ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSM

Résumé 0

Background: One of the main limitations of EVAR during the long-term follow-up is the rate of reintervention mainly caused by the development of endoleaks (EL). The aim of this study was to analyse the characteristics of patients who developed endoleaks at the CHUV after EVAR. Method: Data of all patients who underwent EVAR and who were subject to treatment for endoleaks at the CHUV from 2013 to 2017 were retrospectively collected and analysed. All the parameters at the time of EVAR were analysed Results: The 25 patients were mainly men (80%) with a mean age of 75 years (62-87) at the time of EVAR. The mean aneurysm diameter was 64 mm (40-100) with a neck of 22.7 mm in length. The mean oversizing was 12.8%, and 805 of the stent grafts used were Excluder and Endurant. During the mean follow-up of 58 months (4-164), 47 re-interventions were required after a median time of 13 months following EVAR. Most re-interventions were performed during the first two years after EVAR. There was a majority of type 2 ELs (84% of patients) followed by type 1 (48%). Patients with type 1 EL had the shortest neck (17mm) and mean oversizing inferior to 10%. In the group of patients with type 2 EL, the ratio of circulating blood volume compared to total sac volume was the highest and the thrombus the thinnest and these patients had bigger lumbar arteries. Conclusion: This single-centre study found type II endoleaks to be the most common type of endoleak and associated with less thrombus and higher ratio of circulating blood. We support the hypothesis that all EVAR should be followed. The preferable way to treat ELs was translumbar embolotherapy for type II endoleaks and prosthetic elongation for type I and III endoleaks. The findings of this study, in parallel to an extensive literature review, enabled a better understanding of local management of endoleaks after EVAR but further studies on bigger population are mandatory.