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Invited Commentary
February 2016

Inflammation, Endoleaks, and Aortic Remodeling—The Chicken or the Egg

Author Affiliations
  • 1Division of Vascular Surgery, Department of Surgery, VA Puget Sound Health Care System and the University of Washington, Seattle
JAMA Surg. 2016;151(2):154. doi:10.1001/jamasurg.2015.3246

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.