Preoperative Predictive Factors for Type II Endoleak: Trying to Define High-Risk Patients

Objective: Type 2 endoleaks (T2E) continue to be the "Achilles Heel" of endovascular aneurysm repair (EVAR). The aim of this study is to analyze preoperative factors of patients who underwent EVAR to define risk factors for T2E.Methods: From January 2015 to June 2020, 140 of 191 patients who underwent EVAR in our institution meet inclusion criteria for this study. Postoperative image control were performed using duplex ultra-sound or CT scan. All T2E detected during follow-up were confirmed by angio CT. Preoperative anatomic and clinical variables were analyzed for T2E using t-test, Mann-Whitney U test and Fisher exact test. ROC curves and the corresponding area under the curve (AUC) were used to describe the predictive accuracy for endoleak. Results: T2E was detected in 16 patients (11.43%)0.12 of them (75%) were persistent and 10 (62.5%) provoked sac enlargement. Predictive factors for T2E were a greater IMA diameter (2.5 +/- 0.5 vs. 3.3 +/- 0.5, p < 0.001) and an increasing number of LA (4.8 +/- 1.6 vs. 6.7 +/- 1.4, p < 0.001). ROC curve analysis stablished thresholds of 3.5 mm for IMA diameter (sensitivity 77%, specificity 86%) and 5.5 for patent LA (sensitivity 88%, specificity 59%) as risk factor to develop T2E. Conclusions: Preoperative aortic side branches embolization to avoid T2E is not still standarised. We tried to define a group of high-risk patients for T2E. According to our findings, patients with a preoperative IMA> 3 mm and more than 5 patent LA should be considered for pre-EVAR embolization.(c) 2022 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).