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02/01/2015
ref: EJVES Volume 49, Issue 1, January 2015, Pages 104

Re: ‘“Spontaneous Delayed Sealing in Selected Patients With a Primary Type Ia Endoleak After Endovascular Aneurysm Repair.” Does Correcting the Picture Save the Life?’

In the original paper (1), All but one of the 15 primary type Ia endoleaks sealed spontaneously within 5 months. The disappearance of type Ia endoleaks resulted from improved graft wall apposition due to neck remodelling or thrombosis of the non-apposed neck segment.

However, although ruptures were not detected in the 14 patients, sac growth occurred in four (28.5%).1 In these patients known causes of sac growth were not detected by CT. 

Biomechanical explanation (which does make sense indeed) is that If the barrier between the aneurysm sac and the systemic arterial circulation consists of thrombus only, systemic pressure can be transmitted through a clot, and it is known that mural thrombus on the surface of the aneurysm sac does not prevent rupture.(2) For this reason, a thrombotic barrier on the neck segment may eliminate type Ia endoleak but may not prevent rupture. 

Solution – Maybe by introducing a stiff barrier that prevent from transferring the pressure down into the sac. Feng et al.3 documented results of patients treated by fibrin glue injection: one aneurysm related death and four aneurysm sac growths were detected in 48 cases during 45 months follow up.
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  • 1) F.B. Gonçalvez, H.J.M. Verhagen, K. Vasanthananthan, H.J.A. Zandvoort, F.L. Moll, J.A. van Herwaarden
  • Spontaneous delayed sealing in selected patients with a primary type Ia endoleak after endovascular aneurysm repair
    Eur J Vasc Endovasc Surg, 48 (2014), pp. 53–59
  • 2) F.J. Veith, R.A. Baum, T. Ohki, M. Amor, M. Adiseshiah, J.D. Blankensteijn, et al.
  • Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference
  • J Vasc Surg, 35 (2002), pp. 1029–1035
  • 3) J.X. Feng, Q.S. Lu, Z.P. Jing, Y. Yang, B. Nie, J.M. Bao, et al.
  • Fibrin glue embolization treating intra-operative type I endoleak of endovascular repair of abdominal aortic aneurysm: long-term result
  • Zhonghua Wai Ke Za Zhi, 49 (10) (2011), pp. 883–887

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