Intrasac flow velocities predict sealing of type II endoleaks after endovascular abdominal aortic aneurysm repair☆☆☆★

Purpose: The purpose of this study was to determine whether intrasac spectral Doppler flow velocities can predict whether or not a type II endoleak will spontaneously seal and to relate intrasac flow to preoperative branch vessel anatomy. Methods: Between October 1996 and June 2002, 265 patients with abdominal aortic aneurysms underwent endovascular repair. Patients with less than 24 months of follow-up and type I endoleaks were excluded. Type II endoleaks were confirmed with duplex scan and computed tomographic angiography. Two groups were identified: 14 patients with sealed endoleaks (<6 months) without intervention and 16 patients with persistent endoleaks greater than 6 months and without resolution. Spectral Doppler flow velocities were recorded from endoleaks within the aneurysm sac. Results: The two groups were similar in age, demographics, and aneurysm morphology. The mean follow-up times were 29.9 ± 7.9 months for sealed endoleaks and 30.2 ± 8.6 months for persistent endoleaks (P = not significant). Spectral Doppler velocities were significantly lower in patients with sealed endoleaks compared with persistent endoleaks (75.5 ± 78.8 cm/s versus 138.2 ± 36.2 cm/s; P < .01). Patients with sealed endoleaks and low (<100 cm/s) intrasac Doppler velocities had significantly fewer patent inferior mesenteric arteries (43% versus 81%; P < .01), a smaller inferior mesenteric artery (5.6 ± 1.8 mm versus 7.2 ± 1.3 mm; P < .01), and fewer paired lumbar arteries (1.3 ± 0.8 versus 2.4 ± 0.6; P < .0001) compared with those with persistent endoleaks and high (>100 cm/s) intrasac flow velocities. Three patients with sealed endoleaks had Doppler velocities of 200 cm/s or greater. However, the diameter of the inferior mesenteric artery in these patients was 4 mm or less with no visualized lumbar arteries before surgery. Aneurysm diameter(−4.6 ± 5.6 mm) and volume (−0.9 ± 45.2 mL) decreased in patients with sealed endoleaks. Aneurysm diameter (1.8 ± 4.9 mm) and volume (18.5 ± 33.9 mL) increased slightly in patients with persistent endoleaks (P < .05). No ruptures or conversions occurred in any patient. Secondary interventions to treat type II endoleaks were unsuccessful in six of 16 patients (38%) with persistent endoleaks. Conclusion: Intrasac Doppler velocities can be used to predict whether a type II endoleak will spontaneously seal. High-velocity type II endoleaks are related to preoperative large branch vessel diameter and number and are resistant to endovascular treatment. (J Vasc Surg 2003;37:8-15.)