LAUSR

INTRODUCTION AND OBJECTIVE Long-term success of endovascular aneurysm repair (EVAR) is limited by complications, most importantly endoleaks. In case of (persistent) type I endoleak (T1EL), secondary intervention is indicated to prevent secondary aneurysm rupture. Different treatment options are suggested for T1ELs, such as endo anchors, (fenestrated) cuffs, embolization, or open conversion. Nowadays, treatment of T1EL with liquid embolic agents is available, however results are not yet addressed. This review presents the safety and efficacy of embolization with liquid embolic agents for treatment of T1ELs after EVAR. METHODS A systematic literature search was performed for all studies reporting the use of liquid embolic agents as monotherapy for treatment of T1ELs after EVAR. Patient numbers, technical success (successful delivery of liquid embolics in the T1EL) and clinical success (absence of aneurysm related death, endoleak recurrence or additional interventions during follow-up) were examined. RESULTS From 1604 manuscripts, 10 studies met the selection criteria, including 194 patients treated with liquid embolics; 73.2% were male with a median age of 71 years. The overall technical success was 97.9%. Clinical success was 87.6%. Because the median follow-up was only 13.0 months (range 1-89), data on long-term success is almost absent. Four cases (2.1%) of secondary aneurysm rupture after embolization due to endoleak recurrence were reported. All ruptures occurred in aneurysms exceeding initial treatment diameter of 70 mm. CONCLUSION Initial technical success after liquid embolization for T1EL is high although long-term clinical success rates are lacking. Within this review the risk of secondary rupture is comparable to untreated T1EL at 2% with a median follow-up of thirteen months, regardless to the initial success of embolization. In general, no reduction in secondary aneurysm rupture after embolization of T1EL following EVAR is demonstrated, especially late embolization has arguable results.