Endoleaks (EL), defined as continued perfusion of the aneurysm sac despite stent-graft deployment, are the most common adverse event after endovascular aortic repair (EVAR) and account for most of the… Click to show full abstract
Endoleaks (EL), defined as continued perfusion of the aneurysm sac despite stent-graft deployment, are the most common adverse event after endovascular aortic repair (EVAR) and account for most of the re-interventions. Type 2 EL (T2EL), caused by backflow of collateral arteries into the aneurysm sac, are the most frequently encountered and may account for the need for secondary interventions after EVAR in up to 40% of the cases. Contrast-enhanced ultrasound and magnetic resonance imaging may be better able to quantify and characterize low-flow T2EL as compared with computed tomography angiography. Support for conservative management of T2EL derives from the relatively high percentage of T2EL that will resolve spontaneously over a variable period (more than 30%) and the estimated low risk of post-EVAR rupture secondary to isolated T2EL (less than 1%). Current guidelines are that a conservative approach is appropriate for isolated T2EL without sac expansion while intervention is recommended when sac enlargement of ≥10mm as compared with pre-EVAR is detected. Although generally safe, secondary interventions for T2EL are often unsatisfactory since persistence or recurrence are commonly encountered problems and long-term follow-up is mandatory. Further investigation is required to determine the factors associated with AAA progression in the presence of isolated T2EL and the most cost-effective technique to manage this complication.
               
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