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Open Operative Ligation of Type II Endoleaks Result in a Safe and Durable Repair
William B Harris, Larry R Sprouse, Jr., Christopher J Lesar, Charles S Joels, Jeffrey S Horn, Michael Greer, Daniel Fisher
University of Tennessee, Chattanooga, Chattanooga, TN

Objectives
The continued expansion of infrarenal abdominal aortic aneurysms in patients with persistent type II endoleaks refractory to endovascular management presents a challenge to the practicing vascular surgeon. Open repair of these endoleaks is a viable therapeutic option.
Methods
A retrospective review of medical records of all Endovascular Aortic Aneursym Repairs conducted at our institution in a 7 year span was conducted. All patients who underwent open ligation of type II endoleaks were included in the study. Patients were followed postoperatively with serial duplex ultrasounds to rule out further endoleak and determine sac diameter.
Results
We identified 10 patients that underwent open operative ligation of type II endoleak. All aortic sacs were explored. One patient required infrarenal cross-clamping with subsequent fixation of the proximal aorta to the device. No patients required explantation of the graft. All patients had persistent lumbar arteries feeding the aneurysm sac that were ligated. There were no perioperative deaths. Mean length of hospital stay was 5 days (range 3-9). Perioperative complication rate was 20%, with one patient experiencing cardiac arrhythmias postoperatively and another patient developing a hematoma requiring operative evacuation. On follow-up duplex ultrasonography, no residual type II endoleaks were identified in any of the treated patients. Moreover, no aortic sac expansion was seen in any patient. Average follow-up was 13.6 months (Range 4-28mo).
Conclusions
Open repair of abdominal aortic type II endoleaks is a durable method of treating endoleaks refractory to endovascular management. This can be done with low morbidity and mortality with long-lasting results.


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