Objective: To analyze the incidence and predictive factors of endoleaks and associated increased aneurysm size after thoracic endovascular aortic repair (TEVAR).

Materials and Methods: The medical records and computed tomography (CT) angiography imaging of 69 patients with thoracic aortic aneurysm that underwent thoracic endovascular aortic repair at a single institute between June 2012 and May 2019 were reviewed. The incidences of endoleak were calculated. The patients’ demographic data, operative details, and imaging data were collected. The risk factors of endoleak occurrence were analyzed between endoleak and non-endoleak groups. The association between endoleak and aneurysm enlargement was also evaluated.

Results: Endoleaks were noted in twenty-nine cases (42.0%) including four type Ia (5.8%), six type Ib (8.7%), seventeen type II (24.6%), and two type III (2.9%). Fifty-nine percent of the patients with endoleak were found with aneurysm enlargement. The predictive factors of endoleak were bird beak configuration and distal neck length of less than 20 mm (p=0.014 and 0.019, respectively). For type Ia, endoleak presented with short proximal neck length (p=0.031). Short distal neck and angulation of distal stent less than 160 degrees were the predictive factors of type Ib endoleak (p=0.045 and <0.001, respectively). Increased number of intercostal arteries is the only significant risk factor of type II endoleak (p=0.005). The other complications were endograft migration in about 5.8%, endograft infection in 2.9%, cerebrovascular complications in 5.8%, and ruptured aortic aneurysm in 2.9%.

Conclusion: Interval follow up CT angiography is recommended to detect endoleak and other late complications after TEVAR. Special considerations are noted in the underlying renal insufficiency and the young patient for radiation dose in long term follow up.

Keywords: Endoleak, Thoracic endovascular aortic repair, Thoracic aortic aneurysm, CT angiography, Aneurysm enlargement

DOI: doi.org/10.35755/jmedassocthai.2021.05.11324

Received 9 April 2020 | Revised 3 August 2020 | Accepted 10 August 2020