CLINICAL CONSEQUENCES OF PERIPROSTHETIC LEAK AFTER ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC-ANEURYSM

Purpose: The study was conducted to evaluate risk factors, natural his tory, and clinical consequences of a periprosthetic leak after endovas cular repair of an abdominal aortic aneurysm. Methods: We reviewed the initial and follow-up data, including angiograms, contrast-enhanced c omputed tomography (CT) scans, abdominal duplex scans, and plain abdom inal films for all patients undergoing tube graft repair using the end ovascular graft system (early prototype) between February 10, 1993, an d January 24, 1995. Results: Sixty-eight patients underwent placement or attempted placement of a tube graft implant in 13 centers in the Un ited States. Nine patients required conversion to open repair, leaving 59 patients with functioning grafts for evaluation. The mean follow-u p time was 27 +/- 8 months (range, 2 to 48 months). Twenty-eight (47%) of 59 patients had initial periprosthetic leaks (6 proximal, 14 dista l, 3 proximal and distal, 5 indeterminate) on their first postoperativ e CT scans. Fourteen (50%) of the initial 28 leaks sealed spontaneousl y. Two other patients had their leaks sealed by endovascular means, le aving 12 patients with persistent leaks for follow-up evaluation. Four patients developed late leaks between 18 and 24 months of follow-up: one mho had a spontaneously sealed initial leak, one with a second lea k, and two who developed late leaks. Of the 16 patients with sealed le aks, 10 had aneurysm size reduction during follow-up. Three aneurysm s acs enlarged before spontaneous sealing but have not had sufficient fo llow-up time to document the size change since the seal. One patient d ied of respiratory failure 5 months after graft implantation. One pati ent whose leak was sealed by intervention has not yet had a CT scan fo r evaluation. In one patient with a sealed leak and whose aneurysm had initially shrunk, the area reopened and progressed to a nonfatal rupt ure that was surgically corrected. There mere two late deaths from unr elated causes. Twelve patients in the sealed group are alive and well. Of the 12 patients with persistent leaks, five underwent open surgica l repair without complication, and one underwent successful endovascul ar repair with a second graft. Six patients continue to live with thei r initial grafts and have an average aneurysm sac enlargement of 0.1 c m per year. Conclusions: Although initial periprosthetic leaks were co mmon with the use of this early prototype, 50% spontaneously sealed. T he subsequent clinical course of patients with persistently sealed lea ks was no different from that of patients who had no leaks. However, c ontinued CT surveillance is warranted, because in one patient with an initially sealed leak, the area reopened and progressed to nonfatal ru pture. Another two patients without initial leaks developed late leaks . In a small group of selected patients with continued leaks, their an eurysms appeared to enlarge at a rate considerably slower than would h ave been expected in patients with untreated aneurysm, suggesting that even a person after endovascular repair with a persistent leak may ha ve had some beneficial hemodynamic modification.