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J Thorac Cardiovasc Surg 2009;138:880-885
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Predictive factors for endoleaks after thoracic aortic aneurysm endograft repair

^a Department of Surgical Sciences, Vascular Surgery Unit, Varese University Hospital, Varese, Italy
^b Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy
^c Department of Radiology, Varese University Hospital, Varese, Italy
^d Anaesthesia and Palliative Care, Varese University Hospital, Varese, Italy
^e Department of Cardiac Surgery, 1st Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Lodz, Poland

Received for publication July 10, 2008; revisions received December 5, 2008; accepted for publication February 3, 2009.

^_* Address for reprints: Giovanni Mariscalco, MD, PhD, Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Viale Guicciardini 9, 21100 Varese, Italy. (Email: giovannimariscalco{at}yahoo.it).

Background: Our prospective investigation aimed to determine and analyze the incidence and the determinants of endoleaks after thoracic stent graft.

Methods: Sixty-one patients affected by thoracic aortic aneurysms were treated between January 2000 and March 2008. The study cohort contained 54 men, with a mean age of 63.6 ± 17.9 years. The follow-up imaging protocol included chest radiographs and triple-phase computed tomographic angiography performed at 1, 4, and 12 postoperative months and annually thereafter.

Results: Median follow-up was 32.4 months (range: 1–96 months). Endoleaks were detected in 9 (14.7%) patients, of which 7 were type 1. Five endoleaks were detected at 30 postoperative days, and the other 4 developed with a mean delay of 12 months. Endovascular or hybrid interventions were used to treat the endoleaks. Secondary technical success rate was 100%. Multivariate analysis demonstrated that the diameter of the aneurysmal aorta (odds ratio 1.75, 95% confidence interval 1.07–2.86) and the coverage of the left subclavian artery (odds ratio 12.05, 95% confidence interval 1.28–113.30) were independently associated with endoleak development. The percentages of patients in whom reinterventions were unnecessary were 94.6% ± 3.0%, 88.3% ± 4.5%, and 85.4% ± 5.2%, at 1, 2, and 5 years, respectively. The actuarial survival estimates at 1, 2, and 5 years were 85.2% ± 4.6%, 78.1% ± 5.4%, and 70.6% ± 6.4%, respectively.

Conclusions: The diameter of the aneurysmal aorta and the position of the landing zone are independent predictors of endoleak occurrence after thoracic stent-graft procedures. A careful follow-up program should be considered in patients in whom these indices are unfavorable, because most of the endoleaks may be successfully and promptly treated by additional endovascular procedures.

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