Endoleak as a Complication of Endoluminal Grafting of Abdominal Aortic Aneurysms: Classification, Incidence, Diagnosis, and Management

Abstract

The inability to obtain or maintain a secure seal between a vessel wall and a transluminally implanted intra-aneurysmal graft is a complication unique to the evolving technique of endovascular aneurysm exclusion. Because the term “leak” has long been associated with aneurysm rupture, the term “endoleak” is proposed as a more definitive description of this phenomenon. Embracing both persistent blood flow into the aneurysmal sac from within or around the graft (graft related) and from patent collateral arteries (nongraft related), endoleak can be classified as primary or secondary depending on the time of occurrence (within 30 days of implantation or following apparent initial seal, respectively). Diagnostic techniques to detect endoleak include arteriography, intraprocedural pressure monitoring, contrast-enhanced computed tomography, abdominal X ray, and duplex scanning. Management strategies for endoleak range from observation with periodic imaging surveillance to correction by additional endoluminal or surgical procedures. Standardization of the terminology describing this important sequela to endovascular aneurysm exclusion should facilitate uniform reporting of clinical trial data vital to the evaluation of this emerging technique.

Spontaneous intracerebral haemorrhage: a rare complication of aortic aneurysm endoleak

“…It is a common complication of endovascular repair of aortic aneurysms, identified in up to 30% of thoracic EVARs 8. There are four types of endoleak each indicating the point at which systemic blood is in communication with the aneurysmal sac 9. Of the cases of endoleak-related DIC within the literature, four were type I, two type II and three type III 1–7…”

Failure of aneurysm occlusion by flow diverter: a role for surgical bypass and parent artery occlusion

“…The term ‘endoleak’ was first used to distinguish perigraft contrast filling seen on follow-up imaging from the extravasation of blood outside the aorta implying aneurysm rupture 17. This problem was initially classified by timing and site of leak, and has been further codified into types I–V, based on the location or cause of the endoleak 18.…”

Endovascular Repair of the Thoracic Aorta

“…18 Affecting up to 20% of the patients, 2-7,10,11 endoleak is the most commonly reported complication of TEVAR and is the most important risk factor for aortic rupture. Endoleaks account for the majority of reinterventions.…”