Are Endoleaks Type Ia Predictable?

Objectives Aortic proximal (type Ia) endoleak (EL) is one of the possible complications of endovascular aneurysm repair (EVAR) and usually needs a further reintervention. The aim of our study was to assess any preoperative factor which could predict the development of EL Ia and whether it is treatable through an endovascular approach. Methods Data of patients consecutively treated between January 2012 and December 2015 with EVAR for nonruptured abdominal aortic aneurysm (AAA) were retrospectively collected. For each patient, demographic and anatomical factors (sex, age, proximal aortic neck diameter, angulation and length, AAA diameter) and structural characteristics of different endograft (presence of barbs, free flow, and radial force) were analyzed and related to the development of EL Ia using JMP 5.1.2 software. Results We analyzed 190 patients (32 females [16.8%]; mean age, 75.7 years). The mean follow-up time was 19 months. Patients’ mean AAA diameter was 55.9 mm (range, 30-130 mm). A late EL Ia developed in 13 patients (7%), with a mean time of development of <12 months. Among factors analyzed, AAA diameter, proximal neck diameter and angulation, oversize of the graft >30%, radial force, and the presence of suprarenal free flow and barbs were not significantly associated to the development of EL Ia. Female sex, age >77 years and a neck length <21 mm were statistically significant (P = .01, P = .02, and P = .02, respectively). Conclusions Among factors analyzed, female sex, age >77 years, and a proximal neck <21 mm were significantly associated with the occurrence of late EL Ia.