Evaluation of Delayed Endoleak Compared with Early Endoleak after Endovascular Aneurysm Repair

Purpose: To identify prevalence and evaluate outcomes of delayed endoleak (DEL) compared with early endoleak (EEL) after endovascular aortic aneurysm repair (EVAR). Materials and Methods: Data of 164 patients who underwent elective EVAR at a single center were retrospectively analyzed. DEL was defined as any type of endoleak that was first detected >= 12 months after EVAR. Patients who had <1 year of follow-up were excluded. Endoleak was classified into a more aggressive category if a patient had > 1 type of endoleak. Analysis included 81 patients (82.7% male). Mean age was 73.1 years +/- 9.3. Median follow-up duration was 43 months (range, 12-135 months). Results: Endoleak was present in 32 patients (39.5%), including 21 EEL (25.9%) and 11 DEL (13.6%). DEL consisted of 2 type I, 5 type II, 1 type III, and 3 type V (endotension). Median time to detection was 45 months (range, 15-60 months), and median follow-up duration was 62 months (range, 37-104 months). Compared with EEL, DEL had larger aneurysm diameters and higher rates of non-type II endoleak and reintervention. Type 11 DEL also required more reintervention procedures than type II EEL. Conclusions: DEL had a noteworthy incidence and occurred late after EVAR. It predominantly consisted of non-type 11 endoleak and appeared to have more reinterventions than EEL. Meticulous long-term imaging surveillance to identify and manage DEL is critical.