phology. One of the remaining concerns is uncertainty about the long-term effect of persistent blood flow within the aneurysm sac after endovascular grafting, an occurrence known as endoleak. 1 In fact, endoleak development constitutes one of the prime reasons to perform postoperative surveillance by regularly performed image studies, usually computed tomography (CT) scanning. [2][3][4] The main purpose of EAR is to prevent death from rupture of the aneurysm, and early identification of endoleaks is intended to help obtain this goal. Protocols for when and how to manage endoleaks have been suggested, despite conflicting opinions on the natural history of endoleaks. 5 Several investigators consider the presence of perigraft flow to be evidence of failed treatment because it may predict aneurysmal enlargement and eventual rupture. 6-8 A contrasting opinion was presented in a recent study in which no relation between early endoleaks and late rupture, conversion to open surgery, and death could be demonstrated. 9 From this latter report, it might be concluded that the observation of perigraft flow had little consequence for the ultimate fate of the patient.Clinical management of endoleak may differ between types of endoleak. A generally accepted classification dis-Although the durability of endovascular repair of abdominal aortic aneurysms (AAAs) (EAR) is not definitively established, this treatment method is increasing in popularity among patients and doctors. Physicians from different vascular-oriented disciplines have engaged in workshops and training sessions to learn how to perform the technique in patients with suitable aneurysm mor-461 Objective: The purpose of this study was to assess the incidence, risk factors, and consequences of endoleaks after endovascular repair of abdominal aortic aneurysm. Methods: Data on 2463 patients were collected from 87 European centers and recorded in a central database. Preoperative data were compared for patients with collateral retrograde perfusion (type II) endoleak (group A), patients with devicerelated (type I and III) endoleaks (group B), and patients in whom no endoleak was detected (group C). Only endoleaks observed after the first postoperative month of follow-up were taken into consideration. Regression analysis was performed to investigate statistical relationships between the occurrence and type of endoleak and preoperative patient and morphologic characteristics, operative details, type of device, and experience of the operating team. In addition, postoperative changes in aneurysmal morphology, the need for secondary interventions, conversions to open repair, aneurysmal rupture, and mortality during follow-up were compared between these study groups. Results: Patients in group A had a higher prevalence of a patent inferior mesenteric artery compared with patients without endoleak. Patients in group B were treated more frequently than patients in group C by an operating team with experience of less than 30 procedures. The mean follow-up period was 15.4 months. Seco...

Harvesting of the lower extremity deep veins is well tolerated. Autogenous reconstruction with these veins provides good potential for salvage of life and limbs in case of prosthetic infection. A longer period of follow-up is required to study the long-term behavior of these grafts and to allow definite comparison with more conventional approaches.

in situ reconstruction with the lower extremity deep veins is in the long term a safe and attractive alternative in the treatment of infrarenal aortic graft infection.

Endovascular sealing of AEF is a promising technique, which provides time to treat shock, local and systemic infection, and co-morbidity. This creates a better situation to perform open repair in the future with possibly better outcome. Danger of reinfection remains high. Endovascular sealing of AEF should, therefore, be seen as a bridge to open surgery when possible.

No abstract