Characteristics and risk factors of type I or II endoleak after thoracic endovascular aortic repair and open surgery

Fan Zhu ^1,2,3 Jia Chen ⁴ Yuanyuan Guo ^1* Chang Shu ^2,3*

• ¹ Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Disease Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650000, China., Kunming, China
• ² Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China., Changsha, China
• ³ Vascular Diseases Institute of Central South University, Changsha, 410011, China., Changsha, China
• ⁴ Department of Laboratory Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai Municipality, China

Background: Type I endoleak (T1EL) and type II endoleak (T2EL) are the most severe complications that occur after thoracic endovascular aortic repair (TEVAR) and open surgery. The purpose of this investigation was to analyze the predictors and multiple risk factors of T1EL and T2EL with a particular focus on the diameter of false lumen and pathology of the left subclavian artery.Methods: 245 patients (mean age 57 ± 13 years) who had undergone open surgery or TEVAR were recruited and thereafter followed for a mean of 18 ± 10 months. Seven patients (2.8%) fell into the T1EL group and seven (2.8%) into the T2EL group. Contrast-enhanced computed tomography angiography (CTA) of the entire aorta confirmed the diagnosis of aortic disease (e.g., thoracic aortic dissection, thoracic aortic aneurysm, and/or type B intramural hematoma) as well as the presence of T1EL or T2EL.Results: Reoperation was more common in the T1EL group (n = 4; 57%) than in the T2EL group (n = 2; 29%); also, reintervention for stenting of the thoracic endovascular graft was more common in the T1EL group (4 vs. 1). In T1EL group, four (57%) patients accepted reoperation owing to progressive enlargement of the false lumen's diameter (aneurysm >55 mm) (n = 4; 100%) as well as sharp, persistent pain in the chest and back (n = 4; 100%). In the T2EL group, two (29%) patients required reintervention owing to the false lumen's growth rate (>5 mm in diameter per half year) as well as symptoms of pulmonary vascular compression such as hemoptysis and dyspnea (n = 2; 100%). The median survival of patients in the T1EL and T2EL groups was 31 months (95% confidence interval [CI] 0.0937-11.4) and 30 months (95% CI 0.08775-10.67), respectively. The proximal opening angle of the LSA (OR 3.141, 95% CI 2.615-3.773) was significantly associated with the incidence of T1EL. The proximal opening angle of the LSA and its diameter were significantly associated with the occurrence of T2EL.To prevent the occurrence of T1EL and T2EL, appropriate stent grafts and the pathology of the LSA should be carefully considered.