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

Abstract

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. 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 nondegenerative 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); secondary outcomes were endoleak-related reintervention, open conversion, and all-cause mortality. 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 = .475). Sac expansion occurred in 21 (32.3%) and 16 (7.0%) of the patients in the T2EL and non-T2EL groups, respectively (P < .001). Endoleak-related reintervention was performed in 12 (18.5%) patients with T2EL and 9 (4.0%) without T2EL (P < .001). All-cause mortality occurred in 19 patients (29.2%) with T2EL and 68 (30.0%) without T2EL (P = .282). In multivariable analysis, T2EL at 1 month was independently linked to sac expansion (hazard ratio, 4.75; 95% confidence interval, 2.09-10.78; P < .001) and endoleak-related reintervention (hazard ratio, 3.08; 95% confidence interval, 1.10-8.61; P = .032). 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 increased all-cause mortality, its presence should be monitored closely. These findings supported the prognostic value of T2EL at 1 month in predicting adverse aortic outcomes after EVAR.