Endoleaks after endovascular repair of abdominal aortic aneurysm: detection and management.

The term “endoleak” refers to persistent blood flow into the aneurysmal sac after endovascular aneurysm repair (EVAR). Endotension has been defined as a state of elevated pressure within the aneurysmal sac after EVAR without evidence of endoleak, on delayed contrast computed tomography (CT) scans. In the Eurostar Registry the prevalence during follow-up was 19.8% for endoleaks (7.8% were type II leaks and 12% were type I or III or multiple leaks) and 5.4% for endotension. Helical CT is recognized as the test of choice, but color-coded Duplex ultrasonography (US) seems to be a good alternative to CT scan up to date. Endoleaks may be classified into 4 categories: the type of the endoleak can suggest the method of study and lead to different treatments; discussion of various treatment options is carried out based on the single type of endoleak. Conclusive remarks emphasize that : a) the presence of endoleak correlates with high risk for aneurysmal rupture and/or conversion after EVAR; b) enhanced ultrasound seems the best method to detect, to assess and to control the endoleaks; c) type I and type III leaks are associated with a significantly greater risk of rupture than type II endoleaks; d) recommended guidelines for indications can decrease the risk of endoleaks, as well as an appropriate patient selection and the employment of new generations of grafts; e) the treatment of type I and type III endoleaks should be aggressive and endovascular, if possible; f) type II leaks should be treated when the aneurysmal sac expands and when pulsations of the sac are seen on US; lumbar embolization or laparoscopic branches ligation are first choice techniques.