Imaging-Based Predictors of Persistent Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

OBJECTIVE. The purpose of this study is to determine the imaging-based parameters associated with the occurrence of persistent type II endoleaks after endovascular abdominal aortic aneurysm repair. MATERIALS AND METHODS. We reviewed the imaging and clinical data for 47 patients with early-onset type II endoleak after endovascular repair. Various predictors of persistent type II endoleaks were analyzed on the basis of preoperative CT findings. In addition, the appearance time of endoleak cavity on the operative angiogram and the relative attenuation of the endoleak cavity in the arterial phase image from the first postoperative CT study were analyzed. RESULTS. The early-onset type II endoleak resolved spontaneously in 22 patients (i.e., the transient group), whereas it was identified on CT studies of the remaining 25 patients 6 months after endovascular repair (i.e., the persistent group). The appearance time of the endoleak cavity on angiographic examination was significantly shorter in the persistent group than in the transient group (mean [+/- SD] appearance time, 4.7 +/- 0.3 s vs 8.8 +/- 0.3 s). The relative attenuation of the endoleak cavity on the first postoperative CT scan was also significantly higher in the persistent group than in the transient group (mean, 0.70 +/- 0.03 vs 0.30 +/- 0.04). For each parameter, ROC analysis revealed the following cutoff points for predicting persistent type II endoleak: 6 seconds for the appearance time of the endoleak cavity (sensitivity, 88%; specificity, 86%), and 0.5 for the relative attenuation of the endoleak cavity (sensitivity, 80%; specificity, 95%). Evaluation of other imaging-based parameters revealed no statistically significant differences between the groups. CONCLUSION. The appearance time of the endoleak cavity on the final operative angiogram and the attenuation of the endoleak cavity on the first postoperative CT scan can be strong imaging-based predictors of persistent type II endoleak.