Endovascular management of "endoleaks" after transluminal infrarenal abdominal aneurysm repair.

Abstract

To investigate the reasons for endoleaks after transluminal infrarenal abdominal aneurysm management and the potential for transluminal interventions in subsequent management. Prospective analysis of 50 consecutive patients undergoing endovascular aneurysm repair at a single institution with Stentor and Vanguard grafts from March 1995 to March 1997. Academic teaching hospital. Two procedures were converted for other reasons than leak. In the remaining 48 successful procedures endoleaks were detected in 11 (22.9%): proximal aortic leak (2.1%), distal aortic leak (8.3%), iliac leak (12.5%). Leaks were treated at the initial procedure in five patients, resulting in 87.5% excluded aneurysms. Twelve and a half per cent were discharged with a primary leak. Redo was performed on all iliac leaks within 7 weeks. All aortic leaks showed spontaneous thrombosis within 3 months, but reappeared with local aneurysm expansion. Aortic redo-procedures were performed by proximal tubular extension or converting a tube graft into a bifurcation graft. All rescue procedures were successful. Secondary leaks have been observed twice in this series, both treated by endovascular means. Endovascular treatment of primary and secondary endoleaks is possible, and may be a safe alternative to a difficult open procedure.