{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:47:01Z","timestamp":1777942021713,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Endovascular Surg"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate outcomes in patients with type 2 endoleak (T2E) and the impact of treatment outside the device instructions for use (IFU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective single-center study included abdominal aortic aneurysms (AAA) patients who underwent EVAR (2011- 2024). Primary outcomes were 30-day and mid-term complications, reintervention, and mortality by T2E status. Propensity score matching was applied and secondary analysis stratified outcomes by IFU compliance, comparing within (\n                      <jats:sub>in<\/jats:sub>\n                      IFU) or outside(\n                      <jats:sub>out<\/jats:sub>\n                      IFU) IFU in each T2E group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 154 EVAR patients (137 men (89.1%) and 17 women (11.0%); mean age 77.5 \u00b1 7.6 years), 77 were T2E(\u2212), and 77 were T2E(+). Baseline characteristics were similar. Thirty-day complications were comparable (T2E(\u2212): 5, 6.4% vs T2E(+): 2, 2.56%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.72). The mean follow-up duration was 2.7 \u00b1 2.4 years. Sac diameter change (\u0394) decreased in the T2E(\u2212) (7.7 \u00b1 8.4\u00a0mm) and enlarged in the T2E(+) (1.79 \u00b1 12.5\u00a0mm;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01). Mid-term graft-related complications (T2E(\u2212): 3, 3.8% vs T2E(+): 49, 62.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01) and reinterventions (T2E(\u2212): 3, 3.8%, vs T2E(+): 20, 25.6%\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01) were higher in the T2E(+) with no difference in mortality (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 1.00). These findings remained after excluding type 1 endoleaks. Among the T2E(+), those treated\n                      <jats:sub>out<\/jats:sub>\n                      IFU had longer hospital stays (\n                      <jats:sub>out<\/jats:sub>\n                      IFU: 3.0 \u00b1 2.8 days vs\n                      <jats:sub>in<\/jats:sub>\n                      IFU: 1.8 \u00b1 2.0 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03), higher T1E (\n                      <jats:sub>out<\/jats:sub>\n                      IFU: 3, 33.3% vs\n                      <jats:sub>in<\/jats:sub>\n                      IFU: 1, 4.34%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01), higher rates of reintervention (\n                      <jats:sub>out<\/jats:sub>\n                      IFU: 9, 100.0% vs\n                      <jats:sub>in<\/jats:sub>\n                      IFU:17; 24.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01) and higher all-cause mortality than those within IFU criteria (\n                      <jats:sub>out<\/jats:sub>\n                      IFU: 5, 55.0% vs\n                      <jats:sub>in<\/jats:sub>\n                      IFU: 13, 18.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01). IFU status did not significantly affect outcomes in T2E(\u2212) patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      T2E is associated with sac growth and increased reinterventions, but not higher mortality. On subgroup analysis, those T2E(+) treated\n                      <jats:sub>out<\/jats:sub>\n                      IFU had longer hospitalizations, higher T1E rates, more reinterventions, and higher all-cause; but not aneurysmal-related mortality.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15385744251395118","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T22:17:21Z","timestamp":1761949041000},"page":"297-308","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Higher Risk for Morbidity and Non-Aortic Related Mortality in Type 2 Endoleak Patients Treated Outside of Instructions for Use"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4795-3367","authenticated-orcid":false,"given":"Camila","family":"Esquetini-Vernon","sequence":"first","affiliation":[{"name":"Mayo 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