Type II Endoleak After EVAR: Sac Growth and Reintervention in Long-Term Follow-Up
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ID: 315720
2026
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Abstract
Abstract Background The clinical significance of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR) remains controversial. Although typically considered harmless, T2EL has been associated with postoperative aneurysm sac enlargement. Aims To evaluate aneurysm sac diameter changes and rate of reinterventions in patients with T2EL after EVAR in a single-center cohort. Methods We performed a retrospective single-center review of patients undergoing infrarenal EVAR between 2014 and 2024. Patients with ≥1.5 years of follow-up with CT angiography were included. Sac growth or shrinkage was defined as a ≥5 mm increase or decrease in diameter. Aneurysm sac changes and reinterventions due to isolated T2EL were analyzed further. Results The cohort included 195 patients with a mean follow-up of 54 months. Overall, sac shrinkage occurred in 116 patients (59.5%), sac growth in 31 (15.9%), and no relevant change in 48 (24.6%). Sac growth within the first postoperative year occurred in 2.6%. Patients without any endoleaks (n=78) demonstrated a higher rate of shrinkage (n=63, 80.8%) and minimal growth (n=1, 1.3%). Patients with isolated T2EL (n=87) had less shrinkage (n=45, 51.7%) and increased sac growth (n=18, 10.7%). Of those, 14 patients (16.1%) underwent reintervention, mainly due to proximal or distal sealing zone dilation. No secondary ruptures occurred. Coiling was performed in 4 (4.6%) cases, 2 of which showed sac shrinkage afterwards. Conclusion Isolated T2EL is associated with significantly higher aneurysm sac growth compared to patients without endoleak. In these patients reintervention was necessary in 16.1%. The absence of rupture suggests that sac growth related to T2EL may be managed safely with strict CT surveillance to detect complications such as progressive sealing zone dilation and shortening.
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| Authors | S Ruddakies, S Hofer |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag055.081
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| URL | |
| Keywords | Keywords not found |
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