Laparoscopic Transperitoneal Repair for the Management of Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

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Abstract
Background: Type II endoleak (T2EL) remains a significant cause of reintervention after endovascular aneurysm repair (EVAR). Current strategies for T2EL management remain suboptimal with low long-term efficacy. Thus, this study aimed to evaluate the feasibility and outcomes of laparoscopic transperitoneal branch artery ligation for T2EL management. Methods: This study included 6 patients with persistent T2EL and aneurysm sac expansion who underwent laparoscopic ligation of the culprit vessels, including the inferior mesenteric, lumbar, and median sacral arteries, at our center between January 2021 and January 2024. Preoperative basic clinical characteristics, operative data, postoperative outcomes, and complications of the patients were recorded and analyzed. Results: The median operative time was 225 minutes (range: 120–360 min) with blood loss of 300 mL (range: 50–500 mL). All patients achieved complete ligation of targeted vessels (median of 5 vessels per patient), with 100% success for the inferior mesenteric artery (IMA) and 50% for the median sacral artery. One patient developed a lymphatic fistula that was managed conservatively. At a median follow-up of 13.5 months (range: 4–54 months), all patients exhibited sac regression (median reduction: 3.5 mm; range: 1–8 mm). Complete endoleak resolution was observed in 4 cases (66.7%), while 2 had asymptomatic persistent T2EL without expansion. No reinterventions or mortality occurred. Conclusions: Laparoscopic transperitoneal branch artery ligation represents a promising, albeit preliminary, option for managing embolization-refractory T2EL. Our findings suggest that laparoscopic T2EL repair may provide durable sac stabilization in selected patients; however, the limited sample size underscores the need for larger studies to clarify patient selection criteria and long-term durability.
Funding Information
  • Peking University People’s Hospital Research and Development Funds (RDJP2023-14)
  • Beijing Xicheng District Science and Technology Special Projects (XCSTS-SD2022-05)

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