Endovascular Treatment of Type II Endoleaks: Update and Overview

Abstract

Endoleaks are a common complication following endovascular aneurysm repair, despite EVAR being the preferred method for the repair of abdominal aortic aneurysms. Endoleaks are continued blood flow into the aneurysmal sac, or more broadly elevated pressure outside of the endograft, and are classified into five types based on the source of blood flow or elevated pressure. Type II endoleaks are the most common and are a result of retrograde flow to the sac most commonly from the inferior mesenteric artery or lumbar artery. Endovascular treatment options for type II endoleaks include transarterial, transcaval, translumbar, and transabdominal approaches. This review discusses the indication for endovascular treatment of type II endoleaks, the selection of approach, and technical considerations.

Keywords

interventional radiology - aneurysm - endoleak - endograft - embolization

Publication History

Article published online:
24 December 2024

• References

• 1 Chaikof EL, Dalman RL, Eskandari MK. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67 (01) 2-77.e2
• 2 Guirguis-Blake JM, Beil TL, Senger CA, Coppola EL. Primary care screening for abdominal aortic aneurysm: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2019; 322 (22) 2219-2238
• 3 Veith FJ, Marin ML, Cynamon J, Schonholz C, Parodi J. 1992: Parodi, Montefiore, and the first abdominal aortic aneurysm stent graft in the United States. Ann Vasc Surg 2005; 19 (05) 749-751
• 4 Walker TG, Kalva SP, Yeddula K. et al; Society of Interventional Radiology Standards of Practice Committee, Interventional Radiological Society of Europe, Canadian Interventional Radiology Association. Clinical practice guidelines for endovascular abdominal aortic aneurysm repair: written by the Standards of Practice Committee for the Society of Interventional Radiology and endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21 (11) 1632-1655
• 5 Cifuentes S, Mendes BC, Tabiei A, Scali ST, Oderich GS, DeMartino RR. Management of endoleaks after elective infrarenal aortic endovascular aneurysm repair: a review. JAMA Surg 2023; 158 (09) 965-973
• 6 Chun JY, de Haan M, Maleux G, Osman A, Cannavale A, Morgan R. CIRSE standards of practice on management of endoleaks following endovascular aneurysm repair. Cardiovasc Intervent Radiol 2024; 47 (02) 161-176
• 7 Baum RA, Stavropoulos SW, Fairman RM, Carpenter JP. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 2003; 14 (9, Pt 1): 1111-1117
• 8 Chen JX, Stavropoulos SW. Type 2 endoleak management. Semin Intervent Radiol 2020; 37 (04) 365-370
• 9 Zener R, Oreopoulos G, Beecroft R, Rajan DK, Jaskolka J, Tan KT. Transabdominal direct sac puncture embolization of type II endoleaks after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol 2018; 29 (08) 1167-1173
• 10 Contrella BN, Wilkins LR, Sheeran DP, Khaja MS, Angle JF. Predictive value of preprocedural computed tomography angiography for the technical success of transarterial embolization of type II endoleaks arising from the lumbar arteries. J Vasc Interv Radiol 2021; 32 (07) 1016-1021
• 11 Nana P, Spanos K, Heidemann F. et al. Systematic review on transcaval embolization for type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2022; 76 (01) 282-291.e2
• 12 Heidemann F, Rohlffs F, Tsilimparis N. et al. Transcaval embolization for type II endoleak after endovascular aortic repair of infrarenal, juxtarenal, and type IV thoracoabdominal aortic aneurysm. J Vasc Surg 2021; 74 (01) 38-44
• 13 Burley CG, Kumar MH, Bhatti WA, Boyd C, Sales CM. Transcaval embolization as the preferred approach. J Vasc Surg 2019; 69 (04) 1309-1313
• 14 Scott CK, Driessen AL, Gonzalez MS. et al. Benefits of contrast-enhanced ultrasound during endoleak treatment. J Vasc Surg 2021; 74 (03) e94
• 15 Rhee R, Oderich G, Hertault A. et al. Multicenter experience in translumbar type II endoleak treatment in the hybrid room with needle trajectory planning and fusion guidance. J Vasc Surg 2020; 72 (03) 1043-1049
• 16 Szeto H, Graif A, Patel A. et al. Abstract no. 37 the perigraft approach for type II endoleak embolization. J Vasc Interv Radiol 2023; 34 (03) S18-S19
• 17 Coppi G, Saitta G, Coppi G, Gennai S, Lauricella A, Silingardi R. Transealing: a novel and simple technique for embolization of type 2 endoleaks through direct sac access from the distal stent-graft landing zone. Eur J Vasc Endovasc Surg 2014; 47 (04) 394-401
• 18 Chivot C, Bouzerar R, Yzet T, Reix T. Transarterial perigraft balloon-assisted onyx embolization of type II endoleak. J Vasc Interv Radiol 2019; 30 (04) 617-619
• 19 Matsumura H, Wada H, Teratani H, Amako M, Hayashida Y, Minematsu N. Transgraft embolization by using long needle for the treatment of type II endoleaks after endovascular abdominal aortic repair. J Vasc Surg Cases Innov Tech 2020; 6 (04) 590-594
• 20 Mewissen MW, Jan MF, Kuten D, Krajcer Z. Laser-assisted transgraft embolization: a technique for the treatment of type II endoleaks. J Vasc Interv Radiol 2017; 28 (11) 1600-1603
• 21 Khaja MS, Park AW, Swee W. et al. Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Intervent Radiol 2014; 37 (03) 613-622
• 22 Vance AZ, Graif A, Patel R. et al. Outcome and technical evolution of type 2 endoleak embolization with ethylene-vinyl-alcohol copolymer. Vascular 2023; 31 (01) 10-17
• 23 Scallan O, Kribs S, Power AH, DeRose G, Duncan A, Dubois L. Onyx versus coil embolization for the treatment of type II endoleaks. J Vasc Surg 2021; 73 (06) 1966-1972
• 24 Kim MK, Park YJ, Yang SS. et al. Comparison between Onyx and coil embolization for persistent type 2 endoleaks after endovascular aneurysm repair. Ann Surg Treat Res 2024; 106 (03) 178-187
• 25 Mozes GD, Pather K, Oderich GS. et al. Outcomes of Onyx® embolization of type II endoleaks after endovascular repair of abdominal aortic aneurysms. Ann Vasc Surg 2020; 67: 223-231
• 26 Choi SY, Lee DY, Lee KH. et al. Treatment of type I endoleaks after endovascular aneurysm repair of infrarenal abdominal aortic aneurysm: usefulness of N-butyl cyanoacrylate embolization in cases of failed secondary endovascular intervention. J Vasc Interv Radiol 2011; 22 (02) 155-162
• 27 Lagios K, Karaolanis G, Bazinas T, Perdikides T, Bountouris I. Translumbar infusion of N-butyl cyanoacrylate for the treatment of type II endoleaks. J Vasc Interv Radiol 2018; 29 (06) 826-832
• 28 Zhang X, Ji L, Chen MY, Wang W, Zheng YH. Transarterial embolization versus translumbar embolization for type II Endoleak after endovascular abdominal aortic aneurysm repair: a meta-analysis. Chin Med Sci J 2020; 35 (02) 135-141
• 29 Guo Q, Zhao J, Ma Y. et al. A meta-analysis of translumbar embolization versus transarterial embolization for type II endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2020; 71 (03) 1029-1034.e1
• 30 Hamidizadeh R, Nzekwu E, Halliwell O. Factors influencing clinical success following endovascular treatment of type II Endoleaks. Can Assoc Radiol J 2021; 72 (04) 890-897
• 31 Moosavi B, Kaitoukov Y, Khatchikian A, Bayne JP, Constantin A, Camlioglu E. Direct sac puncture versus transarterial embolization of type II endoleaks after endovascular abdominal aortic aneurysm repair: comparison of outcomes. Vascular 2024; 32 (03) 499-506
• 32 Iwakoshi S, Ogawa Y, Dake MD. et al. Outcomes of embolization procedures for type II endoleaks following endovascular abdominal aortic repair. J Vasc Surg 2023; 77 (01) 114-121.e2
• 33 Vandenbulcke R, Houthoofd S, Laenen A. et al. Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up. Diagn Interv Radiol 2023; 29 (02) 331-341