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.

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

“…Endovascular abdominal aortic aneurysm repair with metal endoprosthesis (EVAR) has become particularly significant as an alternative to traditional surgery, due to less early mortality and complications and a low rate of aneurysm rupture [1,2,[12][13][14][15].…”

A importância do diagnóstico por imagem na classificação dos endoleaks como complicação do tratamento endovascular de aneurismas aórticos

“…Currently, the classification most recommended by the vascular surgeon's societies is the one developed by White et al, that was modified in recent years, dividing endoleaks into five types (19)(20)(21) . This classification is based on the origin of the blood flow into the aneurysmal sac and has direct implication on the treatment required for each case.…”

“…Multidetector CT angiography is the imaging method of choice for the followup of these patients, because of the high sensitivity of the method in the identification of endoleaks and other complications associated with the procedure (19,25) .…”

Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

“…24 Other studies reported finding signs of previous endoleaks in post-EVAR aneurysm ruptures; therefore, endoleaks are aggressively evaluated and treated if they persist beyond the 6-month follow-up, unless the aneurysm sac has shrunk. 14,25,26 Because persistent T2Es are significant contributors to late adverse outcomes such as aneurysm rupture, conversion to open repair, aneurysm sac growth and the need for reintervention, several treatment options are available for the management of T2Es (Box 3). However, the management of T2Es is hotly debated because of diverse personal experience and beliefs concerning the long-term outcome of the various approaches.…”