Step-by-Step Approach to Management of Type II Endoleaks

Seventy-five percent of abdominal aortic aneurysms are now treated by endovascular aneurysm repair (EVAR) rather than open repair, given the decreased periprocedural mortality, complications, and length of hospital stay for EVAR compared to the surgical counterpart. An endoleak is a potential compli...

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Bibliographic Details
Published in:Techniques in vascular and interventional radiology 2018-09, Vol.21 (3), p.188-195
Main Authors: Bryce, Yolanda, Lam, Cuong (Ken), Ganguli, Suvranu, Schiro, Brian J., Cooper, Kyle, Cline, Michael, Oklu, Rahmi, Vatakencherry, Geogy, Peña, Constantino S., Gandhi, Ripal T.
Format: Article
Language:English
Subjects:
Aortic Aneurysm, Abdominal - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Computed Tomography Angiography
Contrast Media
endoleak
Endoleak - diagnostic imaging
Endoleak - therapy
endovascular aneurysm repair
Endovascular Procedures
Humans
Postoperative Complications - diagnostic imaging
Postoperative Complications - therapy
translumbar embolization
type II endoleak
Ultrasonography, Interventional
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Summary:Seventy-five percent of abdominal aortic aneurysms are now treated by endovascular aneurysm repair (EVAR) rather than open repair, given the decreased periprocedural mortality, complications, and length of hospital stay for EVAR compared to the surgical counterpart. An endoleak is a potential complication after EVAR, characterized by continued perfusion of the aneurysm sac after stent graft placement. Type II endoleak is the most common endoleak, and often has a benign course with spontaneous resolution, occurring in the first 6 months after repair. However, these type II endoleaks may result in pressurization of the aneurysm sac and potentially sac rupture. They occur from retrograde collateral blood flow into the aneurysm sac, typically from a lumbar artery or the inferior mesenteric artery. Alternative sources include accessory renal, gonadal, median sacral arteries, and the internal iliac artery. We will discuss our protocol for post-EVAR imaging surveillance and potential type II endoleak treatment strategies, including transarterial, translumbar, transcaval, and perigraft approaches, as well as open surgery.
ISSN:1089-2516
1557-9808
DOI:10.1053/j.tvir.2018.06.009