Aortic Branches Artery Closure and Aneurysmorrhaphy for Type II Endoleak after Endovascular Aortic Repair

Abstract

Objective: Persistent endoleak (EL) is a major cause of aneurysmal enlargement or rupture after endovascular aneurysm repair (EVAR). Treatment strategy for type II EL (T2EL) remains controversial. Methods: From February 2012 to August 2022, we performed 151 EVARs using Excluder (WL Gore and Associates, Flagstaff, AZ, USA). Patients with increased aneurysm diameter of ≥5 mm post-EVAR were considered for retreatment. Aortic branches artery closure and aneurysmorrhaphy (BACA) through laparotomy was performed in 11 patients (11 men, mean age 75.6±4.4 years). We retrospectively reviewed the BACA outcomes. Results: The overall retreatment rate was 8.6%. The interval from the primary EVAR was 49.7±16.2 months. The operation time was 183±37 min and postoperative hospital stay was 14.6±2.6 days. Aneurysm shrank gradually in all patients. No surgical or aneurysm-related deaths were observed during the observation period of 19.2±9.5 months. Conclusion: Early BACA results were favorable, although long-term results require further investigation. Although aneurysmal re-enlargement after BACA may occur, aneurysm-related event would be delayed because the BACA shrank sac diameter. Therefore, BACA is an acceptable procedure, considering the patients’ backgrounds.