Resultados em longo prazo de embolização de endoleaks tipo II

Eduardo da Silva Eli; Júlia Jochen Broering; David Ernesto Timaran; Carlos Hernando Timaran

doi:10.1590/1677-5449.008415

Original Article

Resultados em longo prazo de embolização de endoleaks tipo II

Long-term outcomes of embolization of type II endoleaks

Eduardo da Silva Eli; Júlia Jochen Broering; David Ernesto Timaran; Carlos Hernando Timaran

http://dx.doi.org/10.1590/1677-5449.008415 J Vasc Bras, vol.15, n1, p.11-15, 2016

PDF

Downloads: 0

Resumo

Resumo Contexto Endoleaks tipo II são frequentes após o reparo endovascular de aneurismas de aorta. Objetivo O objetivo deste estudo foi comparar o sucesso da embolização de endoleaks tipo II utilizando diferentes técnicas e materiais. Métodos Entre 2003 e 2015, 31 pacientes foram submetidos a embolização de endoleak tipo II, totalizando 41 procedimentos. Esses procedimentos foram conduzidos por acesso translombar, acesso femoral ou uma combinação de ambos, utilizando Onyx®18, Onyx®34, coils, plugue vascular Amplatzer® e trombina como material emboligênico. Sucesso foi definido como ausência de reintervenção. O teste de qui-quadrado e o teste exato de Fisher foram utilizados para a análise estatística. Resultados O tempo médio entre a correção do aneurisma de aorta e a embolização foi de 14 meses. Quinze (36%) das intervenções utilizaram Onyx®18; sete (17%) utilizaram coils e Onyx®34; seis (14%) utilizaram Onyx®34; quatro (10%) utilizaram coils e Onyx®18; quatro (10%) usaram Onyx®18 e Onyx®34; e três (7%) usaram coils e trombina; um (2%) usou coils e um (2%) usou Amplatzer®. Onze pacientes (35%) necessitaram de reintervenção. A taxa de sucesso foi de 71,43% (10) para os pacientes com as artérias lombares como fonte do endoleak, 80% (8) quando a fonte era a artéria mesentérica inferior e 40% (2) quando havia combinação de ambas (p & 0,05). Não houve diferença estatisticamente significativa com relação ao tipo de embolização, material emboligênico e tipo de reparo da aorta para a correção do aneurisma. Conclusões A terapia endovascular de endoleaks tipo II é um desafio, sendo necessária reintervenção em até 36% dos casos. A taxa de sucesso é menor quando o endoleak é nutrido pela combinação das artérias lombares e da artéria mesentérica inferior.

Palavras-chave

endoleak tipo II, embolização, endoleak

Abstract

Abstract Background Type II endoleaks are common after endovascular aortic aneurysm repair. The purpose of this study was to assess the long-term outcomes of embolization of type II endoleaks using different techniques and materials. Methods Between 2003 and 2015, 31 patients underwent embolization of type II endoleaks, in a total of 41 procedures. Patients underwent transarterial or translumbar embolization using Onyx®18, Onyx®34, coils, Amplatzer® plug and/or thrombin. Embolization success was defined as no endoleak reintervention. The chi-square test and Fisher’s exact test were used for statistical analysis. Results Median embolization time after aortic aneurysm repair was 14 months. Fifteen (36%) embolization interventions were performed using Onyx®18; seven (17%) with coils and Onyx®34; six (14%) with Onyx®34; four (10%) with coils and Onyx® 18; four with Onyx®18 and Onyx®34; three (7%) with coils and thrombin; one (2%) with coils; and one (2%) with an Amplatzer® device. Eleven patients (35%) required reintervention. The embolization success rate was 71.43% (10) for patients with lumbar arteries as the source of the endoleak, 80% (8) for the inferior mesenteric artery and 40% (2) when both inferior mesenteric artery and lumbar arteries were the culprit vessels (p & 0.05). There was no statistically significant difference with regards to type of embolization, embolic material or type of previous aortic repair. Conclusions Endovascular treatment of type II endoleaks is challenging and reintervention is needed in up to 36% of patients. Endoleaks supplied by both the inferior mesenteric artery and the lumbar arteries have a lower rate of success.

Keywords

type II endoleak, embolization, endoleak

References

Avgerinos ED, Chaer RA, Makaroun MS, Type II. Endoleaks. J Vasc Surg. 2014;60(5):1386-91.

Stather PW, Sidloff D, Dattani N, Choke E, Bown MJ, Sayers RD. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg. 2013;100(7):863-72.

Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular Repair of Abdominal Aortic Aneurysm. Cochrane Database Syst Rev. 2014;1:CD004178.

Haulon S, Tyazi A, Willoteaux S, Koussa M, Lions C, Beregi JP. Embolization of type II endoleaks after aorticstent-graft implantation: Technique andimmediate results. J Vasc Surg. 2001;34(4):600-5.

Parent FN, Meier GH, Godziachvili V. The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg. 2002;35(3):474-81.

Veith FJ, Baum RA, Ohki T. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international confer- ence. J Vasc Surg. 2002;35(5):1029-35.

Waasdorp E, van Herwaarden JA, van de Mortel RH, Moll FL, de Vries JP. Early computed tomographic angiography after endovascular aneurysm re- pair: worthwhile or worthless?. Vascular. 2008;16(5):253-7.

Van Marrewijk CJ, Fransen G, Laheij RJF. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg. 2004;27:128e37.

Steinmetz E, Rubin BG, Sanchez LA. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J Vasc Surg. 2004;39:306e13.

Rayt HS, Sandford RM, Salem M. Conservative management of type 2 endoleaks is not associated with increased risk of aneurysm rupture. Eur J Vasc Endovasc Surg. 2009;38:718e23.

Nevala T, Biancari F, Manninen H. Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Intervent Radiol. 2010;33:278e84.

Walker J, Tucker LY, Goodney P. Type II endoleak with or without intervention after endovascular aortic aneurysm repair does not change aneurysm-related outcomes despite sac growth. J Vasc Surg. 2015;62(3):551-61.

Hajibandeh S, Ahmad N, Antoniou GA, Torella F. Is intervention better than surveillance in patients with type 2 endoleak post-endovascular abdominal aortic aneurysm repair?. Interact Cardiovasc Thorac Surg. 2015;20(1):128-34.

Jouhannet C, Alsac JM, Julia P. Reinterventions for type 2 endoleaks with enlargement of the aneurismal sac after endovascular treatment of abdominal aortic aneurysms. Ann Vasc Surg. 2014;28(1):192-200.

Van Bindsbergen L, Braak SJ, van Strijen MJL, de Vries JPPM, Type II. Endoleak embolization after endovascular abdominal aortic aneurysm repair with use of real-time three-dimensional fluoroscopic needle guidance. J Vasc Interv Radiol. 2010;21(9):1443-7.

Stavropoulos SW, Park J, Fairman R, Carpenter J. Type 2 endoleak embolization comparison: translumbar embolization versus modified transarterial embolization. J Vasc Interv Radiol. 2009;20(10):1299-302.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">

Resultados em longo prazo de embolização de endoleaks tipo II

Long-term outcomes of embolization of type II endoleaks

Eduardo da Silva Eli; Júlia Jochen Broering; David Ernesto Timaran; Carlos Hernando Timaran

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

J Vasc Bras