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Clinical predictors of type II endoleaks after EVAR: a systematic review of risk and protective factors.

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Title: Clinical predictors of type II endoleaks after EVAR: a systematic review of risk and protective factors.
Authors: Colonna G; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Fasulo C; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Antonelli M; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Santini A; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Morucci C; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Mazzetti G; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Rizzo L; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Taurino M; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of Molecular and Clinical Medicine, 'Sapienza' University of Rome, Via di Grottarossa, 1035, 00189 Roma RM, Rome, Italy., Sirignano P; Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of General and Specialistic Surgery, 'Sapienza' University of Rome, Piazzale Aldo Moro, 5, 00185 Roma RM, Rome, Italy.
Source: British medical bulletin [Br Med Bull] 2026 Oct 05; Vol. 160 (1).
Publication Type: Journal Article; Systematic Review
Language: English
Journal Info: Publisher: Oxford University Press Country of Publication: England NLM ID: 0376542 Publication Model: Print Cited Medium: Internet ISSN: 1471-8391 (Electronic) Linking ISSN: 00071420 NLM ISO Abbreviation: Br Med Bull Subsets: MEDLINE
Imprint Name(s): Publication: 2001- : London : Oxford University Press
Original Publication: London.
MeSH Terms: Endoleak*/etiology , Endoleak*/prevention & control , Endoleak*/epidemiology , Endovascular Aneurysm Repair*/adverse effects , Endovascular Aneurysm Repair*/methods , Aortic Aneurysm, Abdominal*/surgery , Endovascular Procedures*/adverse effects, Humans ; Risk Factors ; Protective Factors
Abstract: Introduction: The present systematic review seeks to examine clinical factors potentially associated with endovascular aortic aneurysm repair (EVAR) failure due to type II endoleaks (TIIEL).
Source of Data: Relevant literature was sourced from PubMed, including all studies regarding clinical features possibly linked to TIIEL, written in English. Studies focused on anatomical predictors, case reports, and abstracts were excluded. The literature search used keywords related to clinical characteristics, comorbidities, and demographics common in EVAR patients.
Areas of Agreement: EVAR is the preferred treatment for abdominal aortic aneurysms in eligible patients. The most common complication is endoleak (persistent filling of the sac). TIIEL is caused by retrograde blood flow from aortic side branches and is the most frequent complication, occurring in 16%-50% of cases.
Areas of Controversy: Many studies have explored anatomical predictors of TIIEL, but limited research is available on clinical factors that may contribute to its occurrence.
Growing Points: Protective factors against TIIEL included statin therapy, salicylate therapy, smoking, ankle/brachial systolic blood pressure index <0.87, and chronic obstructive pulmonary disease. Conversely, anticoagulation therapy, inflammatory status, and advanced age were associated with an increased risk of TIIEL.
Areas Timely for Developing Research: Further prospective research is needed to validate the presented association between clinical factors and EVAR failure due to TIIEL, to allow risk stratification and tailored follow-up strategies for selected groups of patients.
(© The Author(s) 2026. Published by Oxford University Press.)
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Contributed Indexing: Keywords: EVAR; aortic aneurysm; endoleaks; risk factors
Entry Date(s): Date Created: 20261019 Date Completed: 20261019 Latest Revision: 20261022
Update Code: 20261022
PubMed Central ID: PMC13679749
DOI: 10.1093/bmb/ldag035
PMID: 42896085
Database: MEDLINE
Description
ISSN:1471-8391
DOI:10.1093/bmb/ldag035