Aims: Type II endoleak complicates 10-25 % of EVAR. Although the clinical significance of type II endoleak remains contentious, the strategies used for its management have continued to expand. We systematically review the literature and comprehensively appraise the effectiveness of laparoscopic intervention in the management of this common complication. Methods: Review Methods: were according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Published literature from five electronic databases was searched. Studied outcomes included patient demographic, aneurysm type, graft type, endoleak type, previous endovascular embolization attempted, vessel ligated laparoscopically, length of stay and follow up duration. Results: 9 studies representing 20 patients were investigated. Mean age was 74.4. All patients were ASA II and above. All underwent standard infrarenal EVAR. 16 patients suffered a type II endoleak from the inferior mesenteric artery. 60 % (12/20) patients had unsuccessful or were unsuitable for embolization. 30-day mortality was 5 %. Conclusion: Direct laparoscopic ligation of feeding vessels causing type II endoleak is particularly useful in cases where standard endovascular embolization has failed. It is associated with low 30-day mortality and should be considered an essential tool in the armamentarium of the vascular and laparoscopic surgeon. Key statement Type II endoleak is a common complication post EVAR and cannot always be treated by endovascular means such as embolization. Failure to treat can lead to continued sac pressurisation and aneurysm rupture. Direct laparoscopic ligation is a useful adjunct to the armamentarium of the treatment of this condition.
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