Comparison of treatment outcomes between graft replacement and aneurysmorrhaphy with graft preservation for type 2 endoleaks after endovascular abdominal aortic aneurysm repair.

Objective: This study aimed to compare treatment outcomes between graft replacement and aneurysmorrhaphy with ligation of the aortic side branches for type 2 endoleaks after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms.

Methods: We retrospectively analyzed multicenter data of patients who underwent open surgical conversion, including graft replacement or aneurysmorrhaphy with ligation of the aortic side branches (graft preservation) for the treatment of type 2 endoleaks between 2007 and 2022. The endpoints were postoperative complications, 30-day mortality, overall survival, and reintervention or sac expansion after open surgical conversion.

Results: Forty patients underwent open surgical conversion (graft replacement, n=9; graft preservation, n=31). There were no significant differences in patient characteristics or anatomical data of the initial EVAR between the groups. The median operative time and amount of blood loss were significantly lesser in the graft preservation group than in the replacement group (179 vs. 318 min, P < .001 and 710 vs. 2,567 mL, P = .030, respectively). There was no difference in the occurrence of postoperative complications between the two groups (P = .645). No 30-day mortality was observed in any of the groups. Overall survival rate at 5 years after open surgical conversion was 85.7% in the graft replacement group and 77.8% in the graft preservation group (P = .789). Freedom from sac expansion or reintervention rate at 5 years after open surgical conversion was 100% in the graft replacement group and 76.0% in the graft preservation group (P = .239).

Conclusions: Aneurysmorrhaphy with ligation of the aortic side branches was less invasive treatment compared with graft replacement, although there were no differences in postoperative complications. No reintervention was needed after graft replacement; however, some patients required reintervention after graft preservation. Further studies are needed to determine the optimal surgical procedure for the treatment of type 2 endoleak.