Journal of Orthopaedics and Traumatology

Official Journal of the Italian Society of Orthopaedics and Traumatology

Journal of Orthopaedics and Traumatology Cover Image
Open Access

Reply to the Letter to the Editor. Endoleak after endovascular aortic repair and lumbar vertebral erosion

  • Federico Mancini1,
  • Andrea Ascoli-Marchetti1,
  • Luca Garro1Email author and
  • Roberto Caterini1
Journal of Orthopaedics and TraumatologyOfficial Journal of the Italian Society of Orthopaedics and Traumatology201516:336

Received: 23 October 2014

Accepted: 22 January 2015

Published: 26 February 2015


Public HealthCompute TomographySport MedicineAortic RuptureBranch Vessel
We thank Bozzani and co-workers for their comments [1] regarding this case [2]. It has been emphasized that this type of endoprosthesis does not generally promote rupture. In fact, in the most recent international trial, the incidence of type II endoleak (i.e., abnormal persistent post-endovascular aneurysm repair (EVAR) filling of the aneurysm sac through one or more of the branch vessels) after infrarenal implantation of a polymer-filled endovascular prosthesis was reported to be 34 % [3]; however, a significant increase in the diameter was documented in only one case (0.7 %). Moreover, ruptures did not result at 12-month follow-up but further observation has been recommended [4]. However, in this case the delay between implantation and the occurrence of an aneurysm was less than 1 year. We agree that in most cases the tamponade aortic rupture is determined by an endoleak or endotension. In this case, however, the aneurysm was extremely large (6.2-cm in diameter, Fig. 1), and this condition has been documented as a risk factor for rupture, including in well-positioned vascular endoprosthesis [5]. A computed tomography (CT) scan performed after the spinal procedure did not reveal any signs of an endoleak or bleeding (Fig. 2).
Fig. 1

CT scan performed after EVAR procedure. The aneurysm was >6 cm in diameter

Fig. 2

CT scan performed after spinal surgery showing the absence of infra/suprarenal endoleak


Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Authors’ Affiliations

University of Rome “Tor Vergata”, Rome, Italy


  1. Bozzani A, Arici V, Ragni F, Argenteri A (2014) Endoleak after endovascular aortic repair and lumbar vertebral erosion. J Orthopaed Traumatol. doi:10.1007/s10195-014-0329-4Google Scholar
  2. Mancini F, Ascoli-Marchetti A, Garro L, Caterini R (2014) Aseptic lysis L2-L3 as complication of abdominal aortic aneurysm repair. J Orthopaed Traumatol 15(4):291–294. doi:10.1007/s10195-014-0308-9View ArticleGoogle Scholar
  3. Mehta M, Valdés FE, Nolte T, Mishkel GJ, Jordan WD, Gray B, Eskandari MK, Botti C; A Pivotal Clinical Study to Evaluate the Safety and Effectiveness of the Ovation Abdominal Stent Graft System Investigators (2014) One year outcomes from an international study of the Ovation Abdominal Stent Graft System for endovascular aneurysm repair. J Vasc Surg 59(1):65.e1-3–73.e1-3. doi:10.1016/j.jvs.2013.06.065View ArticleGoogle Scholar
  4. Keith CJ Jr, Passman MA, Gaffud MJ, Novak Z, Pearce BJ, Matthews TC, Patterson MA, Jordan WD Jr (2013) Comparison of outcomes following endovascular repair of abdominal aortic aneurysms based on size threshold. J Vasc Surg 58(6):1458–1466. doi:10.1016/j.jvs.2013.06.060PubMedView ArticleGoogle Scholar
  5. Greiner A, Schleimer K, Jalaie H, Gombert A, Jacobs MJ, Kalder J (2014) Late rupture after EVAR: a new trend? J Cardiovasc Surg (Torino) 55(2 Suppl 1):169–174Google Scholar


© The Author(s) 2015