Abstract：
The longitudinal clinical significance of type II endoleaks (T2ELs) remains controversial. Specifically, the real-world incidence, need for reintervention, and associated mortality referable to T2ELs remain unknown. Moreover, current professional society clinical practice guidelines recommend differing aneurysm sac growth thresholds to prompt intervention. Therefore, the purpose of this analysis was to better quantify the prevalence of early T2ELs after infrarenal endovascular aortic aneurysm repair (EVAR) and determine its association with reintervention and survival.
All elective EVARs from the Vascular Quality Initiative (2010-2020) were examined to identify patients with isolated T2ELs vs no endoleak (NONE) at discharge. Procedures with a type I or III endoleak were excluded. A subgroup analysis was performed on patients surviving beyond the first postoperative year with follow-up data available on endoleaks. The primary outcome was overall survival. Secondary outcomes included perioperative mortality and reinterventions. Outcomes were assessed by multivariable logistic and Cox proportional hazards regression to adjust for covariates.
We identified 53,697 patients who underwent EVAR. The overall incidence of isolated T2ELs at discharge was 16%. In-hospital mortality was lower for those with isolated T2ELs vs NONE (0.8% vs 1.9%, odds ratio: 0.6, 95% confidence interval: 0.5-0.8, P < .0001). Unadjusted overall survival was marginally higher at 5 years for patients with T2ELs vs NONE (84% vs 82%); however, after risk adjustment, survival was similar (hazard ratio: 0.95, 95% confidence interval: 0.9-1.0). Among 44,345 patients with 1-year follow-up, 66% had data on endoleak status for assessment. Survival was similar regardless of endoleak status (NONE, at discharge only, at follow-up only, or at both time points). Among patients with documented T2ELs during follow-up, 6.1% and 2.5% had abdominal aortic aneurysm sac diameter growth ≥5 mm and ≥10 mm, respectively. Reinterventions occurred in 12%. Rupture (1%) and any open reintervention (4%) were rare among patients with 1-year follow-up. For patients with T2ELs, 5-year survival was similar between those with and without reintervention by 1 year (89% vs 91%, log-rank P = .06).
T2ELs remain common after EVAR within the Vascular Quality Initiative and are not associated with long-term mortality. Reinterventions for T2ELs were not associated with improved overall survival among patients with T2ELs. Although additional data surrounding the appropriate role of reintervention for T2ELs remain necessary, it appears that the natural history of T2ELs is benign.
All elective EVARs from the Vascular Quality Initiative (2010-2020) were examined to identify patients with isolated T2ELs vs no endoleak (NONE) at discharge. Procedures with a type I or III endoleak were excluded. A subgroup analysis was performed on patients surviving beyond the first postoperative year with follow-up data available on endoleaks. The primary outcome was overall survival. Secondary outcomes included perioperative mortality and reinterventions. Outcomes were assessed by multivariable logistic and Cox proportional hazards regression to adjust for covariates.
We identified 53,697 patients who underwent EVAR. The overall incidence of isolated T2ELs at discharge was 16%. In-hospital mortality was lower for those with isolated T2ELs vs NONE (0.8% vs 1.9%, odds ratio: 0.6, 95% confidence interval: 0.5-0.8, P < .0001). Unadjusted overall survival was marginally higher at 5 years for patients with T2ELs vs NONE (84% vs 82%); however, after risk adjustment, survival was similar (hazard ratio: 0.95, 95% confidence interval: 0.9-1.0). Among 44,345 patients with 1-year follow-up, 66% had data on endoleak status for assessment. Survival was similar regardless of endoleak status (NONE, at discharge only, at follow-up only, or at both time points). Among patients with documented T2ELs during follow-up, 6.1% and 2.5% had abdominal aortic aneurysm sac diameter growth ≥5 mm and ≥10 mm, respectively. Reinterventions occurred in 12%. Rupture (1%) and any open reintervention (4%) were rare among patients with 1-year follow-up. For patients with T2ELs, 5-year survival was similar between those with and without reintervention by 1 year (89% vs 91%, log-rank P = .06).
T2ELs remain common after EVAR within the Vascular Quality Initiative and are not associated with long-term mortality. Reinterventions for T2ELs were not associated with improved overall survival among patients with T2ELs. Although additional data surrounding the appropriate role of reintervention for T2ELs remain necessary, it appears that the natural history of T2ELs is benign.
摘要：
背景：II型内漏（T2EL）的纵向临床意义仍存在争议。具体来说,真实世界的发病率，需要重新干预，与T2EL相关的死亡率仍然未知。此外，当前的专业社会临床实践指南建议不同的动脉瘤囊生长阈值以提示干预。因此,本分析的目的是更好地量化肾下腔内主动脉瘤修复术(EVAR)后早期T2EL的患病率,并确定其与再干预和生存率的关系.
方法：检查了来自VQI（2010-2020）的所有选择性EVAR，以确定出院时具有孤立的T2EL和无内漏（NONE）的患者。排除具有I型或III型内漏的程序。对存活超过术后第一年的患者进行了亚组分析，并获得了内漏的随访数据。主要结果是总生存率。次要结果包括围手术期死亡率和再干预措施。通过多变量logistic和Cox比例风险回归评估结果，以调整协变量。
结果：我们确定了53,697例接受EVAR的患者。放电时孤立的T2EL的总发生率为16％。孤立的T2EL患者的住院死亡率较低。无（0.8%与1.9%，或0.6，95CI0.5-0.8，p<.0001）。T2EL患者的5年未调整总生存率略高于无（84%与82%)；然而，风险调整后，生存率相似(HR0.95,95CI0.9-1.0).在随访一年的44345例患者中，66%有内漏状态数据用于评估。无论内漏状态如何，生存率都相似(无，仅在放电时，仅在后续行动中，或在两个时间点)。在随访期间有T2EL记录的患者中，6.1%和2.5%的AAA囊直径增长≥5mm和≥10mm，分别。12％的人再次干预。在随访一年的患者中，破裂（1％）和任何开放的再干预（4％）很少见。对于T2EL患者，有和没有再次干预的患者的5年生存率相似（89%vs.91%,对数秩p=.06)。
结论：在VQI的EVAR后，II型内漏仍然很常见，与长期死亡率无关。对T2EL的再干预与T2EL患者总生存率的改善无关。尽管仍需要有关T2EL再干预的适当作用的其他数据，T2EL的自然史似乎是良性的。
方法：检查了来自VQI（2010-2020）的所有选择性EVAR，以确定出院时具有孤立的T2EL和无内漏（NONE）的患者。排除具有I型或III型内漏的程序。对存活超过术后第一年的患者进行了亚组分析，并获得了内漏的随访数据。主要结果是总生存率。次要结果包括围手术期死亡率和再干预措施。通过多变量logistic和Cox比例风险回归评估结果，以调整协变量。
结果：我们确定了53,697例接受EVAR的患者。放电时孤立的T2EL的总发生率为16％。孤立的T2EL患者的住院死亡率较低。无（0.8%与1.9%，或0.6，95CI0.5-0.8，p<.0001）。T2EL患者的5年未调整总生存率略高于无（84%与82%)；然而，风险调整后，生存率相似(HR0.95,95CI0.9-1.0).在随访一年的44345例患者中，66%有内漏状态数据用于评估。无论内漏状态如何，生存率都相似(无，仅在放电时，仅在后续行动中，或在两个时间点)。在随访期间有T2EL记录的患者中，6.1%和2.5%的AAA囊直径增长≥5mm和≥10mm，分别。12％的人再次干预。在随访一年的患者中，破裂（1％）和任何开放的再干预（4％）很少见。对于T2EL患者，有和没有再次干预的患者的5年生存率相似（89%vs.91%,对数秩p=.06)。
结论：在VQI的EVAR后，II型内漏仍然很常见，与长期死亡率无关。对T2EL的再干预与T2EL患者总生存率的改善无关。尽管仍需要有关T2EL再干预的适当作用的其他数据，T2EL的自然史似乎是良性的。
