Type II Endoleak Outcomes After Transcaval Versus Transarterial and Translumbar Approaches

Purpose: Type II endoleaks are the most common complication following endovascular abdominal aortic aneurysm repair (EVAR). There is limited data on the outcomes of transcaval embolization approaches. In this study, we compare the outcomes of a transcaval approach to type II endoleak embolization versus transarterial and translumbar approaches.

Materials and Methods: Single center retrospective review of 69 patients who underwent 93 type II endoleak embolization procedures from August 5, 2011, to June 6, 2024. Clinical, imaging and procedural data were recorded. Complications were classified based on the Society of Interventional Radiology (SIR) adverse events (AE) classification system.

Results:
A total of 69 patients (53 male, 76.8%) underwent 93 type II endoleak embolization procedures. Average age at time of procedure was 78.1 ± 7.4 years. Mean aneurysm sac size at index embolization procedure was 6.5 ± 1.3 cm in the transarterial group, 6.7 ± 1.1 cm in the transcaval group, and 7.1 ±  1.5 cm in the translumbar group (p = 0.18). Technical success, defined as resolution of the type II endoleak on intraprocedural imaging was 39/46 (84.8%) in the transarterial group, 23/23 (100%) in the transcaval group, and 24/24 (100%) in the translumbar group (p < 0.05). Clinical success, defined as decreased aneurysm sac size and/or resolution of type II endoleak not requiring repeat type II endoleak embolization procedure was 29/46 (63.0%) in the transarterial, 14/23 (60.9%) in the transcaval, and 18/24 (75%) in the translumbar group (p = 0.52). Mean increase in aneurysm sac diameter from index embolization to most recent imaging follow up was 0.05 ± 1.15 cm in the transarterial, 0.56 ± 0.93 cm in transcaval, and 0.35 ± 0.97 cm in the translumbar groups (p = 0.16). Follow up time was 856.2 ± 961 days in the transarterial group, 572.5 ± 626.9 days in the transcaval group, and 446.8 ± 548 days in the translumbar group (p = 0.11). Severe AEs occurred in 3/46 transarterial cases. Moderate AEs occurred in 4/23 transcaval cases. There was a single mild AE in translumbar case. There was no difference in overall survival between the groups (p = 0.40).



Conclusion:
The approach to type II endoleak embolization depends on patient characteristics and aneurysm anatomy. In this retrospective review, a transarterial approach demonstrated a statistically significant lower rate of technical success. Clinical success and overall mortality were not significantly different between transarterial, transcaval, and translumbar approaches.