Type II Endoleaks After Endovascular Aneurysm Repair: A Lack of Oxygen?

One year after endovascular aneurysm repair, approximately 5% of patients experience persistent type II endoleaks (T2EL) with a significant increase in the aneurysm diameter (T2EL-IAD). An additional treatment is recommended to prevent a secondary aneurysm rupture: one of the first-line treatments of this T2EL-IAD consists in aneurysm sac embolization, but this procedure is associated with a high risk of persistence or reoccurrence of the endoleaks. In these cases, an open conversion can be necessary, yet it is sometimes impossible for high-risk surgical patients. 1 Wanhainen A. Verzini F. Van Herzeele I. et al. Editor’s choice - European Society for Vascular Surgery (ESVS) 2019 clinical Practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019; 57: 8-93 Abstract Full Text Full Text PDF PubMed Scopus (1503) Google Scholar ,2 Kansal V. Nagpal S. Jetty P. Editor’s choice - late open surgical conversion after endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2018; 55: 163-169 Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar We propose an original hypothesis similar to the physiopathological mechanisms underlying tumor and metastatic development, which can be triggered by local hypoxia (Fig. 1).