Improved results using Onyx glue for the treatment of persistent type 2 endoleak after endovascular aneurysm repair

• Published in: Journal of vascular surgery 2012-09, Vol.56 (3), p.630-636
• Main Authors: Abularrage, Christopher J., MD, Patel, Virendra I., MD, Conrad, Mark F., MD, MMSc, Schneider, Eric B., PhD, Cambria, Richard P., MD, Kwolek, Christopher J., MD
• Format: Article
• Language: English
• Subjects: Aged; Aneurysm - mortality; Aneurysm - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Boston; Cardiology. Vascular system; Chi-Square Distribution; Dimethyl Sulfoxide - adverse effects; Dimethyl Sulfoxide - therapeutic use; Diseases of the aorta; Drug Combinations; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Embolization, Therapeutic - mortality; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - mortality; Endoleak - therapy; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Medical sciences; Multivariate Analysis; Odds Ratio; Polyvinyls - adverse effects; Polyvinyls - therapeutic use; Proportional Hazards Models; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tantalum - adverse effects; Tantalum - therapeutic use; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.02.038

Objective Persistent type 2 (PT2) endoleaks (present ≥6 months) after endovascular aneurysm repair are associated with adverse outcomes, and selective secondary intervention is indicated in those patients with an expanding aneurysm sac. This study evaluated the outcomes of secondary intervention for PT2. Methods From 1999 to 2007, 136 patients who underwent endovascular aneurysm repair developed PT2 and comprised the study cohort. Primary end points included PT2 resolution (secondary interventional success) and survival, and were evaluated using multiple logistic regression and Kaplan-Meier analyses, respectively. Results Fifty-one patients underwent a total of 68 secondary interventions for PT2 with expanding aneurysm sacs with a median postsecondary interventional follow-up of 13.7 months. Secondary interventions included 20 inferior mesenteric artery coil embolizations, 17 Onyx glue embolizations, 11 aneurysm sac coil embolizations, 10 non-Onyx glue embolizations, 7 lumbar artery coil embolizations, 2 open lumbar ligations, and 1 graft explant. The overall secondary interventional success rate was 43% (29 of 68). Onyx glue embolization was associated with a greater success rate when used as the initial secondary intervention (odds ratio, 59.61; 95% confidence interval, 4.78-742.73; P < .001). There was no difference in success between the different techniques when multiple secondary interventions were required. Five-year survival was 72% ± 0.08% and was unrelated to any of the secondary interventional techniques. Conclusions Secondary intervention for PT2 is associated with success in less than half of all cases. Onyx glue embolization was associated with greater long-term success when used as the initial secondary intervention.