Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: A meta-analysis

OBJECTIVES: This systematic review and meta-analysis aims to determine the current evidence on risk factors for type II endoleaks after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: A systematic literature search was carried out for studies that evaluated the association of demographic, co-morbidity, and other patient-determined factors with the onset of type II endoleaks. Pooled prevalence of type II endoleaks after EVAR was updated. RESULTS: Among the 504 studies screened, 45 studies with a total of 36,588 participants were included in this review. The pooled prevalence of type II endoleaks after EVAR was 22% [95% confidence interval (CI), 19%–25%]. The main factors consistently associated with type II endoleaks included age [pooled odds ratio (OR), 0.37; 95% CI, 0.31–0.43; P<0.001], smoking (pooled OR, 0.71; 95% CI, 0.55–0.92; P<0.001), patent inferior mesenteric artery (pooled OR, 1.98; 95% CI, 1.06–3.71; P = 0.012), maximum aneurysm diameter (pooled OR, 0.23; 95% CI, 0.17–0.30; P<0.001), and number of patent lumbar arteries (pooled OR, 3.07; 95% CI, 2.81–3.33; P<0.001). Sex, diabetes, hypertension, anticoagulants, antiplatelet, hyperlipidemia, chronic renal insufficiency, types of graft material, and chronic obstructive pulmonary diseases (COPD) did not show any association with the onset of type II endoleaks. CONCLUSIONS: Clinicians can use the identified risk factors to detect and manage patients at risk of developing type II endoleaks after EVAR. However, further studies are needed to analyze a number of potential risk factors.