Endoleak: Predictive Value for Aneurysm Growth at 3 Years

Endoleak is a unique radiographic finding after endovascular aneurysm repair. The prognostic implication of endoleak on aneurysm therapy outcome is unknown. Patients with 3 years of follow-up were examined to determine the predictive value of endoleak, as determined by the treating physician, for aneurysm growth. Patients enrolled in a clinical trial for a unibody, bifurcated endovascular graft (Ancure-Guidant/EVT, Menlo Park, CA) were examined with respect to endoleak, as determined by the primary investigator, and aneurysm diameter change. A total of 80 patients were available at 3 years for evaluation. CT scans and ultrasound were used to determine endoleak at discharge, at 6 months, and annually. Patients were categorized as no leak (NL; n = 59), early leak (EL, leak identified by 6 months; n = 15), and late leak (LL, leak identified at 12 months or later; n = 6). A change of 5 mm in transverse diameter relative to the original diameter was used to determine an increase or decrease. Therapeutic intervention for endoleak was analyzed separately in each group. From the results we were able to determine that most patients with distal type 1 or type 2 endoleak have shrinking or stable aneurysms. Endoleak is a poor predictor of aneurysm growth but is statistically associated with enlargement. Absence of endoleak is strongly, but not entirely, predictive of lack of aneurysm growth. Endoleak is a risk factor for aneurysm enlargement, warranting further investigation to examine the etiology of the image, but cannot be used as an endpoint for effective endovascular aneurysm treatment.