Type II Endoleak after Endovascular Aneurysm Repair Using the EXCLUDER Stent Graft System in Patients with Abdominal Aortic Aneurysm

<b>Purpose:</b> This study aimed to evaluate type II endoleak incidence and its outcome in patients who underwent endovascular aneurysm repair using the EXCLUDER device for abdominal aortic aneurysm. <b>Material and Methods:</b> One hundred sixty-seven patients who underwent endovascular aneurysm repair for abdominal aortic aneurysm (96 with patent and 71 with occluded inferior mesenteric artery) between 2008 and 2017 were retrospectively evaluated. Type II endoleak incidence and aneurysm enlargement of >5 mm after endovascular aneurysm repair were evaluated. The predictive factors for late type II endoleak identified >6 months after endovascular aneurysm repair and aneurysm enlargement were assessed based on the preoperative patient and anatomical characteristics. <b>Results:</b> Late type II endoleak incidence was higher in the patent inferior mesenteric artery at 42.7% (41/96; 95% confidence interval, 33.3-52.7), compared with 22.5% (16/71; 95% confidence interval, 13.5-34.0) in the occluded inferior mesenteric artery group (p = 0.01). Freedom from aneurysm sac enlargement at 1, 3, and 5 years was 100%, 85.0%, and 68.1% in the patent inferior mesenteric artery and 98.9%, 86.7%, and 73.9% in the occluded inferior mesenteric artery group, respectively (p = 0.22). Freedom from aneurysm sac enlargement at 1, 3, 5 years was 100%, 76.9%, 43.5%, and 99.1%, 90.6% and 87.8% in the patients with and without late type II endoleak (p < 0.01). Patent inferior mesenteric artery (odds ratio, 3.43; 95% confidence interval, 1.43-8.21) and an increasing number of patent lumbar arteries (odds ratio, 2.14; 95% confidence interval, 1.48-3.08) were risk factors for late type II endoleak. <b>Conclusions:</b> Patent inferior mesenteric artery was a risk for late type II endoleak without contributing to aneurysm enlargement after endovascular aneurysm repair using the EXCLUDER. Late type II endoleak was associated with aneurysm enlargement. Patent inferior mesenteric artery and an increasing number of patent lumbar arteries were risk factors for late type II endoleak.