link
Bookmarks
Endoleak Repair
T. Gregory Walker, MD, FSIR
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe

KEY FACTS

  • Terminology

    • Procedure

      • Post Procedure

        TERMINOLOGY

        • Definitions

          • Endoleak: Persistent perfusion of excluded aneurysm sac after endograft placement
            • Type I: Perfusion of aneurysm sac via incomplete/ineffective seal at endograft attachment site
              • Type IA: Originates at proximal attachment site
                • e.g., infrarenal attachment of upper margin of bifurcated abdominal aortic endograft body
              • Type IB: Originates at distal attachment site
                • e.g., common iliac artery attachment of limb of bifurcated abdominal aortic endograft
            • Type II: Perfusion of aneurysm sac via arterial branches arising from excluded aortic segment
              • Similar pathophysiology to arteriovenous malformation
                • Patent arterial side branches continue to perfuse residual abdominal aortic aneurysm (AAA) sac
                • Endoleak within AAA sac acts as nidus; endoleak repair requires elimination of nidus
              • Most common endoleak type
            • Type III: Perfusion of aneurysm sac due to mechanical problem with endograft
              • e.g., ineffective sealing/separation of overlapping graft components, rupture/tear of graft fabric
            • Type IV: Perfusion of aneurysm sac due to graft fabric porosity; rarely seen with current endografts
              • Usually transient; may be related to aggressive intraprocedural anticoagulation
            • Type V: Continued sac enlargement without identifiable endoleak; a.k.a. endotension
              • May represent endoleak that cannot be identified
        • Expectant Management of Endoleaks

          • Type I endoleak
            • Cannot be managed conservatively
              • Represents direct communication with systemic blood flow; high risk of rupture if untreated
                • Invariably requires intervention
          • Type II endoleak
            • Optimal management remains controversial
              • Some investigators advocate immediate repair
              • Other investigators recommend expectant management until aneurysm shows enlargement
                • 17% show enlargement if early type II endoleak
                • 55% of aneurysms show enlargement with persistent (≥ 6 months) type II endoleak
            • Typically has relatively benign course
              • Many seal spontaneously over time; conservative management usually justified
                • 14-25% incidence after endovascular aneurysm repair (EVAR) at 1 month; 10.2% after 1 year
          • Type III endoleak
            • Cannot be managed conservatively
              • Endograft defect or separation of components reperfuses aneurysm sac with systemic blood
                • Invariably requires intervention
          • Type IV endoleak
            • Managed conservatively; occurs infrequently
            • Much less frequent with current endograft technology; improved fabrics
          • Type V endoleak
            • Usually managed conservatively/observed
            • May require intervention if continued sac enlargement, despite lack of endoleak on imaging

        PREPROCEDURE

        • Indications

          • Contraindications

            • Preprocedure Imaging

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Procedure Steps

                    • Alternative Procedures/Therapies

                      POST PROCEDURE

                      • Things To Do

                        OUTCOMES

                        • Complications

                          • Expected Outcomes

                            Selected References

                            1. Seike Y et al: Influence of warfarin therapy on the occurrence of postoperative endoleaks and aneurysm sac enlargement after endovascular abdominal aortic aneurysm repair. Interact Cardiovasc Thorac Surg. ePub, 2017
                            2. Tanious A et al: Endovascular management of proximal fixation loss using parallel stent grafting techniques to preserve visceral flow. Ann Vasc Surg. ePub, 2017
                            3. Yu H et al: Comparison of type II endoleak embolizations: embolization of endoleak nidus only versus embolization of endoleak nidus and branch vessels. J Vasc Interv Radiol. 28(2):176-184, 2017
                            4. Yang RY et al: Direct sac puncture versus transarterial embolization of type II endoleaks: an evaluation and comparison of outcomes. Vascular. 25(3):227-233, 2017
                            5. Böckler D et al: Multicenter Nellix EndoVascular Aneurysm Sealing system experience in aneurysm sac sealing. J Vasc Surg. 62(2):290-8, 2015
                            6. Katsargyris A et al: Endostaples: are they the solution to graft migration and type I endoleaks? J Cardiovasc Surg (Torino). 56(3):363-8, 2015
                            7. Abularrage CJ et al: Improved results using Onyx glue for the treatment of persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg. 56(3):630-6, 2012
                            8. Chaar CI et al: Delayed open conversions after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 55(6):1562-1569, 2012
                            9. Karthikesalingam A et al: Current evidence is insufficient to define an optimal threshold for intervention in isolated type II endoleak after endovascular aneurysm repair. J Endovasc Ther. 19(2):200-8, 2012
                            10. Patatas K et al: Static sac size with a type II endoleak post-endovascular abdominal aortic aneurysm repair: surveillance or embolization? Interact Cardiovasc Thorac Surg. 15(3):462-6, 2012
                            11. Resch T et al: Treatment of endoleaks: techniques and outcome. J Cardiovasc Surg (Torino). 53(1 Suppl 1):91-9, 2012
                            12. Sarac TP et al: Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg. 55(1):33-40, 2012
                            13. Uthoff H et al: Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg. 56(4):965-72, 2012
                            14. Cao P et al: Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair. J Cardiovasc Surg (Torino). 51(1):53-69, 2010
                            15. Cerna M et al: Endotension after endovascular treatment of abdominal aortic aneurysm: percutaneous treatment. J Vasc Surg. 50(3):648-51, 2009
                            16. Jonker FH et al: Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg. 22(3):165-71, 2009
                            Related Anatomy
                            Loading...
                            Related Differential Diagnoses
                            Loading...
                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Procedure

                                • Post Procedure

                                  TERMINOLOGY

                                  • Definitions

                                    • Endoleak: Persistent perfusion of excluded aneurysm sac after endograft placement
                                      • Type I: Perfusion of aneurysm sac via incomplete/ineffective seal at endograft attachment site
                                        • Type IA: Originates at proximal attachment site
                                          • e.g., infrarenal attachment of upper margin of bifurcated abdominal aortic endograft body
                                        • Type IB: Originates at distal attachment site
                                          • e.g., common iliac artery attachment of limb of bifurcated abdominal aortic endograft
                                      • Type II: Perfusion of aneurysm sac via arterial branches arising from excluded aortic segment
                                        • Similar pathophysiology to arteriovenous malformation
                                          • Patent arterial side branches continue to perfuse residual abdominal aortic aneurysm (AAA) sac
                                          • Endoleak within AAA sac acts as nidus; endoleak repair requires elimination of nidus
                                        • Most common endoleak type
                                      • Type III: Perfusion of aneurysm sac due to mechanical problem with endograft
                                        • e.g., ineffective sealing/separation of overlapping graft components, rupture/tear of graft fabric
                                      • Type IV: Perfusion of aneurysm sac due to graft fabric porosity; rarely seen with current endografts
                                        • Usually transient; may be related to aggressive intraprocedural anticoagulation
                                      • Type V: Continued sac enlargement without identifiable endoleak; a.k.a. endotension
                                        • May represent endoleak that cannot be identified
                                  • Expectant Management of Endoleaks

                                    • Type I endoleak
                                      • Cannot be managed conservatively
                                        • Represents direct communication with systemic blood flow; high risk of rupture if untreated
                                          • Invariably requires intervention
                                    • Type II endoleak
                                      • Optimal management remains controversial
                                        • Some investigators advocate immediate repair
                                        • Other investigators recommend expectant management until aneurysm shows enlargement
                                          • 17% show enlargement if early type II endoleak
                                          • 55% of aneurysms show enlargement with persistent (≥ 6 months) type II endoleak
                                      • Typically has relatively benign course
                                        • Many seal spontaneously over time; conservative management usually justified
                                          • 14-25% incidence after endovascular aneurysm repair (EVAR) at 1 month; 10.2% after 1 year
                                    • Type III endoleak
                                      • Cannot be managed conservatively
                                        • Endograft defect or separation of components reperfuses aneurysm sac with systemic blood
                                          • Invariably requires intervention
                                    • Type IV endoleak
                                      • Managed conservatively; occurs infrequently
                                      • Much less frequent with current endograft technology; improved fabrics
                                    • Type V endoleak
                                      • Usually managed conservatively/observed
                                      • May require intervention if continued sac enlargement, despite lack of endoleak on imaging

                                  PREPROCEDURE

                                  • Indications

                                    • Contraindications

                                      • Preprocedure Imaging

                                        • Getting Started

                                          PROCEDURE

                                          • Patient Position/Location

                                            • Procedure Steps

                                              • Alternative Procedures/Therapies

                                                POST PROCEDURE

                                                • Things To Do

                                                  OUTCOMES

                                                  • Complications

                                                    • Expected Outcomes

                                                      Selected References

                                                      1. Seike Y et al: Influence of warfarin therapy on the occurrence of postoperative endoleaks and aneurysm sac enlargement after endovascular abdominal aortic aneurysm repair. Interact Cardiovasc Thorac Surg. ePub, 2017
                                                      2. Tanious A et al: Endovascular management of proximal fixation loss using parallel stent grafting techniques to preserve visceral flow. Ann Vasc Surg. ePub, 2017
                                                      3. Yu H et al: Comparison of type II endoleak embolizations: embolization of endoleak nidus only versus embolization of endoleak nidus and branch vessels. J Vasc Interv Radiol. 28(2):176-184, 2017
                                                      4. Yang RY et al: Direct sac puncture versus transarterial embolization of type II endoleaks: an evaluation and comparison of outcomes. Vascular. 25(3):227-233, 2017
                                                      5. Böckler D et al: Multicenter Nellix EndoVascular Aneurysm Sealing system experience in aneurysm sac sealing. J Vasc Surg. 62(2):290-8, 2015
                                                      6. Katsargyris A et al: Endostaples: are they the solution to graft migration and type I endoleaks? J Cardiovasc Surg (Torino). 56(3):363-8, 2015
                                                      7. Abularrage CJ et al: Improved results using Onyx glue for the treatment of persistent type 2 endoleak after endovascular aneurysm repair. J Vasc Surg. 56(3):630-6, 2012
                                                      8. Chaar CI et al: Delayed open conversions after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 55(6):1562-1569, 2012
                                                      9. Karthikesalingam A et al: Current evidence is insufficient to define an optimal threshold for intervention in isolated type II endoleak after endovascular aneurysm repair. J Endovasc Ther. 19(2):200-8, 2012
                                                      10. Patatas K et al: Static sac size with a type II endoleak post-endovascular abdominal aortic aneurysm repair: surveillance or embolization? Interact Cardiovasc Thorac Surg. 15(3):462-6, 2012
                                                      11. Resch T et al: Treatment of endoleaks: techniques and outcome. J Cardiovasc Surg (Torino). 53(1 Suppl 1):91-9, 2012
                                                      12. Sarac TP et al: Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg. 55(1):33-40, 2012
                                                      13. Uthoff H et al: Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg. 56(4):965-72, 2012
                                                      14. Cao P et al: Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair. J Cardiovasc Surg (Torino). 51(1):53-69, 2010
                                                      15. Cerna M et al: Endotension after endovascular treatment of abdominal aortic aneurysm: percutaneous treatment. J Vasc Surg. 50(3):648-51, 2009
                                                      16. Jonker FH et al: Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg. 22(3):165-71, 2009