{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:29:07Z","timestamp":1783445347257,"version":"3.54.6"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: A type 2 endoleak (EL2) remains the most prevalent complication of endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA). Methods: We conducted a retrospective, single-center analysis, including patients who underwent embolization for an isolated EL2 after EVAR. The study population was stratified into two groups: Group A, consisting of patients whose EL2 resolved after the first embolization procedure, and Group B, consisting of those with refractory EL2 (rEL2). The indication for EL2 treatment was aneurysmal sac growth amounting to &gt;10 mm from the index EVAR. The indications for endograft explantation were the absence of high comorbidities and persisting aneurysmal sac expansion. Those with high comorbidities were subjected to another endovascular procedure or a conservative approach, the latter being preferred. The primary endpoint was EL2 resolution. The secondary endpoints were mid-term outcomes in terms of aneurysmal sac shrinkage, stability and expansion rates, and aneurysm-related complications. Results: Among 57 patients, 19 patients (33.3%) showed signs of EL2 after the first embolization, whereas 38 (66.6%) presented rEL2. Of these, 14 (36.8%) presented significant aneurysmal sac expansion: 8 patients underwent a secondary embolization, while an open conversion was performed in the remaining 6 patients (42.8%), 4 of whom, in an elective setting, showed a complete resolution of EL2, while 2 patients treated in an urgent setting died from a ruptured aneurysm. Among the patients treated with a secondary embolization, only 2 patients presented EL2 resolution, while the other 6 patients (75%) showed rEL2. Out of the 38 patients with rEL2, 24 patients did not undergo further interventions; of these, 11 (45.8%) presented sac expansion, and 16% developed type IA EL. Conclusions: A strict follow-up and possibly a more aggressive treatment should be considered in an elective setting for patients with rEL2.<\/jats:p>","DOI":"10.3390\/jcm14020502","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T11:28:31Z","timestamp":1736854111000},"page":"502","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Early and Mid-Term Outcomes of Isolated Type 2 Endoleak Refractory to an Embolization Procedure"],"prefix":"10.3390","volume":"14","author":[{"given":"Francesca","family":"Miceli","sequence":"first","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6802-4901","authenticated-orcid":false,"given":"Ada","family":"Dajci","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1933-1489","authenticated-orcid":false,"given":"Alessia","family":"Di Girolamo","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio","family":"Nardis","sequence":"additional","affiliation":[{"name":"Radiology Department, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0440-5032","authenticated-orcid":false,"given":"Marta","family":"Ascione","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8745-594X","authenticated-orcid":false,"given":"Rocco","family":"Cangiano","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gattuso","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2125-1151","authenticated-orcid":false,"given":"Antonio","family":"Sterpetti","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2956-6257","authenticated-orcid":false,"given":"Luca","family":"di Marzo","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7774-8178","authenticated-orcid":false,"given":"Wassim","family":"Mansour","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, \u201cSapienza\u201d University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1016\/S0140-6736(16)31135-7","article-title":"Endovascular versus Open Repair of Abdominal Aortic Aneurysm in 15-Years\u2019 Follow-up of the UK Endovascular Aneurysm Repair Trial 1 (EVAR Trial 1): A Randomised Controlled Trial","volume":"388","author":"Patel","year":"2016","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1056\/NEJMoa0909499","article-title":"Long-Term Outcome of Open or Endovascular Repair of Abdominal Aortic Aneurysm","volume":"362","author":"Baas","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1056\/NEJMoa051255","article-title":"Two-Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms","volume":"352","author":"Blankensteijn","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/j.jvs.2010.10.124","article-title":"A Randomized Controlled Trial of Endovascular Aneurysm Repair versus Open Surgery for Abdominal Aortic Aneurysms in Low- to Moderate-Risk Patients","volume":"53","author":"Becquemin","year":"2011","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"The United Kingdom EVAR Trial Investigators (2010). Endovascular versus Open Repair of Abdominal Aortic Aneurysm. N. Engl. J. Med., 362, 1863\u20131871.","DOI":"10.1056\/NEJMoa0909305"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1056\/NEJMoa1715955","article-title":"Open versus Endovascular Repair of Abdominal Aortic Aneurysm","volume":"380","author":"Lederle","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.ejvs.2019.11.030","article-title":"Editor\u2019s Choice\u2014Endovascular vs. Open Repair for Abdominal Aortic Aneurysm: Systematic Review and Meta-Analysis of Updated Peri-Operative and Long Term Data of Randomised Controlled Trials","volume":"59","author":"Antoniou","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100156","DOI":"10.1016\/j.avsurg.2022.100156","article-title":"Ovation Alto Stent-Graft Implantation in Patient with TASC D Aorto-Iliac Lesion and Coexistent AAA\u2014Case Report","volume":"3","author":"Cuozzo","year":"2023","journal-title":"Ann. Vasc. Surg. Brief Rep. Innov."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Girolamo, A.D., Ascione, M., Miceli, F., Mohseni, A., Pranteda, C., Sirignano, P., Taurino, M., di Marzo, L., and Mansour, W. (2024). Clinical and Radiological Outcomes of Accessory Renal Artery Exclusion during Endovascular Repair of Abdominal Aortic Aneurysms. Diagnostics, 14.","DOI":"10.3390\/diagnostics14090864"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1067\/mva.2002.118823","article-title":"Significance of Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms: The EUROSTAR Experience","volume":"35","author":"Buth","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.ejvs.2018.06.009","article-title":"Editor\u2019s Choice\u2014Systematic Review and Meta-Analysis of the Outcome of Treatment for Type II Endoleak Following Endovascular Aneurysm Repair","volume":"56","author":"Ultee","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.avsg.2020.02.013","article-title":"Outcomes of Onyx\u00ae Embolization of Type II Endoleaks After Endovascular Repair of Abdominal Aortic Aneurysms","volume":"67","author":"Mozes","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1016\/j.jvs.2020.10.069","article-title":"Onyx versus Coil Embolization for the Treatment of Type II Endoleaks","volume":"73","author":"Scallan","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.ejvs.2023.11.002","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms","volume":"67","author":"Wanhainen","year":"2024","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jvs.2006.01.010","article-title":"Secondary Interventions Following Endovascular Abdominal Aortic Aneurysm Repair Using Current Endografts. A EUROSTAR Report","volume":"43","author":"Hobo","year":"2006","journal-title":"J. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1177\/15266028221081079","article-title":"Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion","volume":"30","author":"Hatzl","year":"2023","journal-title":"J. Endovasc. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"155","DOI":"10.23736\/S0021-9509.21.12014-2","article-title":"Stability of the Aneurysmatic Sac Post-EVAR Could No Longer Be a Reliable Criterion of Healing","volume":"63","author":"Esposito","year":"2022","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.avsg.2020.12.060","article-title":"Prophylactic Aneurysm Embolization during EVAR Is Safe, Improves Sac Regression and Decreases the Incidence of Type II Endoleak","volume":"74","author":"Mathlouthi","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Niklas, N., Malec, M., Gutowski, P., Kazimierczak, A., and Rynio, P. (2022). Effectiveness of Inferior Mesenteric Artery Embolization on Type II Endoleak-Related Complications after Endovascular Aortic Repair (EVAR): Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11185491"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"312","DOI":"10.2310\/6670.2004.00023","article-title":"Matrix Metalloproteinase 9 Activity in Patients before and after Endovascular or Surgical Repair of Abdominal Aortic Aneurysms","volume":"12","author":"Taurino","year":"2004","journal-title":"Vascular"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sirignano, P., Mangialardi, N., Nespola, M., Aloisi, F., Orrico, M., Ronchey, S., Del Porto, F., and Taurino, M. (2022). Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers. J. Pers. Med., 12.","DOI":"10.3390\/jpm12030339"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.amjcard.2023.03.025","article-title":"C-Reactive Protein and Risk of Cardiovascular Events and Mortality in Patients with Various Cardiovascular Disease Locations","volume":"197","author":"Burger","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1177\/1526602817712511","article-title":"Definition of Type II Endoleak Risk Based on Preoperative Anatomical Characteristics","volume":"24","author":"Piazza","year":"2017","journal-title":"J. Endovasc. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jvs.2007.02.073","article-title":"Persistent Type 2 Endoleak after Endovascular Repair of Abdominal Aortic Aneurysm Is Associated with Adverse Late Outcomes","volume":"46","author":"Jones","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.jvs.2012.10.118","article-title":"Type II Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysm Are Not Always a Benign Condition","volume":"57","author":"Cochennec","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1016\/j.jvs.2003.12.033","article-title":"Predicting Aneurysm Enlargement in Patients with Persistent Type II Endoleaks","volume":"39","author":"Timaran","year":"2004","journal-title":"J. Vasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.jvs.2018.11.022","article-title":"Systematic Review and Meta-Analysis of Elective and Urgent Late Open Conversion after Failed Endovascular Aneurysm Repair","volume":"70","author":"Goudeketting","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.avsg.2013.03.009","article-title":"Outcomes After Late Explantation of Aortic Endografts Depend on Indication for Explantation","volume":"27","author":"Arya","year":"2013","journal-title":"Ann. Vasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.ejvs.2020.01.011","article-title":"Twenty-Two Year Multicentre Experience of Late Open Conversions after Endovascular Abdominal Aneurysm Repair","volume":"59","author":"Perini","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jvs.2018.04.055","article-title":"Late Open Conversions after Endovascular Abdominal Aneurysm Repair in an Urgent Setting","volume":"69","author":"Perini","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"240.e9","DOI":"10.1016\/j.avsg.2012.06.011","article-title":"Persistent Type II Endoleak: Two Cases of Successful Sacotomy","volume":"27","author":"Faccenna","year":"2013","journal-title":"Ann. Vasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.jvs.2009.05.024","article-title":"Open Surgical Repair after Failed Endovascular Aneurysm Repair: Is Endograft Removal Necessary?","volume":"50","author":"Nabi","year":"2009","journal-title":"J. Vasc. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1016\/j.jvs.2015.07.075","article-title":"Surgical Conversion with Graft Salvage as a Definitive Treatment for Persistent Type II Endoleak Causing Sac Enlargement","volume":"62","author":"Mangialardi","year":"2015","journal-title":"J. Vasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/502\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:28:45Z","timestamp":1759919325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020502"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020502","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,14]]}}}