Outcomes of embolization procedures for type II endoleaks following endovascular abdominal aortic repair

Shinichi Iwakoshi, Yukihisa Ogawa, Michael D. Dake, Yusuke Ono, Hiroki Higashihara, Akira Ikoma, Motoki Nakai, Takanori Taniguchi, Takahiro Ogi, Hiroshi Kawada, Akio Tamura, Yoshirou Ieko, Ryoichi Tanaka, Etsuji Sohgawa, Satoru Nagatomi, Reiko Woodhams, Osamu Ikeda, Kensaku Mori, Hiroshi Nishimaki, Jun KoizumiTerutoshi Senokuchi, Makiyo Hagihara, Masashi Shimohira, Shohei Takasugi, Akira Imaizumi, Wataru Higashiura, Shoji Sakaguchi, Shigeo Ichihashi, Takeshi Inoue, Takashi Inoue, Kimihiko Kichikawa

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The objective of this study was to investigate the mid-term outcomes of embolization procedures for type II endoleak after endovascular abdominal aortic repair, and clarify the risk factors for aneurysm enlargement after embolization procedures. Methods: This was a retrospective multicenter registry study enrolling patients who underwent embolization procedures for type II endoleaks after EVAR from January 2012 to December 2018 at 19 Japanese centers. The primary end point was the rate of freedom from aneurysm enlargement, more than 5 mm in the aortic maximum diameter, after an embolization procedure. Demographic, procedural, follow-up, and laboratory data were collected. Continuous variables were summarized descriptively, and Kaplan-Meier analyses and a Cox regression model were used for statistical analyses. Results: A total of 315 patients (248 men and 67 women) were enrolled. The average duration from the initial embolization procedure to the last follow-up was 31.6 ± 24.6 months. The rates of freedom from aneurysm enlargement at 3 and 5 years were 55.4 ± 3.8% and 37.0 ± 5.2%, respectively. A multivariate analysis revealed that a larger aortic diameter at the initial embolization procedure and the presence of a Moyamoya endoleak, defined as heterogeneous contrast opacity with an indistinct faint border, were associated with aneurysm enlargement after embolization management. Conclusions: The embolization procedures were generally ineffective in preventing further expansion of abdominal aortic aneurysms in patients with type II endoleaks after EVAR, especially in patients with a large abdominal aortic aneurysm and/or a presence of a Moyamoya endoleak.

Original languageEnglish (US)
Pages (from-to)114-121.e2
JournalJournal of vascular surgery
Issue number1
StatePublished - Jan 2023


  • EVAR
  • Embolization
  • Endoleak

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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