Shalaby and colleagues1 have taken a fresh look at inflammation and aortic aneurysms by examining the continued remodeling of the residual aneurysmal sac after endovascular repair of infrarenal aortic aneurysms (endovascular aneurysm repair [EVAR]). Two long-term pitfalls for EVAR are endoleaks and continued expansion of the residual sac. The rate of type II endoleaks may be as low as 15%2 or as high as 27%.3 Type II endoleaks usually involve continued flow within the aneurysm sac. Approximately 60% resolve within 6 months, but persistence of a type II endoleak after the first 6 months is associated with higher rates (55%) of aneurysm sac enlargement.2 The search for risk factors for type II endoleaks and sac expansion have primarily focused on anatomical factors (after all, it is a plumbing problem): the number of patent lumbars, the size of the inferior mesenteric artery, the burden of laminated thrombus in the aneurysm, or the technical complexities of the endovascular procedure.
Sobel M, Tang GL. Inflammation, Endoleaks, and Aortic Remodeling—The Chicken or the Egg. JAMA Surg. 2016;151(2):154. doi:10.1001/jamasurg.2015.3246