Early and Late Outcomes of Ultrasound-Guided Direct Transabdominal Embolization of Isolated Type 2 Endoleaks after Endovascular Aortic Repair

Background The aim of this study is to report the early and late outcomes of ultrasound-guided direct transabdominal embolization (UGDTE) of isolated type 2 endoleak (T2EL) after endovascular aneurysm repair (EVAR). Methods Forty-two consecutive T2EL patients were treated between February 2000 and September 2017 by UGDTE after previous EVAR. During the study period, UGDTE was the firs-line technique implemented for treatment of T2EL. All procedures were carried out using the same predefined technique. Aneurysm sac size change from the index treatment, freedom from recurrent endoleak after treatment, demographics, risk factors, and procedural factors were analyzed with univariate analysis. Results During the study interval, 612 patients underwent standard EVAR for abdominal aortic aneurysm treatment and 111 (18.2%) developed an isolated T2EL. Of these, 42 (6.8%) consecutive patients were deemed suitable and treated with UDGT. Median imaging follow-up duration was 18.7 months. Median fluoroscopic and procedure times were 7 and 58 minutes, respectively. The rate of immediate technical success was 100%. Ten patients (23.8%) underwent reintervention for recurrent T2EL. Freedom from reintervention for T2EL at 1, 2, and 4 years was 81%, 78%, and 71%. No aneurysm-related mortality occurred during the follow-up period. Conclusions The use of UGDTE for treatment of isolated T2EL after EVAR is a safe and feasible technique when performed by experienced operators, resulting in high technical success and low complication rates in selected patients. Although being effective in obtaining T2EL exclusion, up to one-third of the patients may require repeat intervention during long-term follow-up. Therefore, lifelong surveillance after the procedure is recommended.