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

Yolanda Bryce, Cuong (Ken) Lam, Suvranu Ganguli, Brian J. Schiro, Kyle Cooper, Michael Cline, Rahmi Oklu, Geogy Vatakencherry, Constantino S. Peña, Ripal T. Gandhi

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
JournalTechniques in Vascular and Interventional Radiology
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • endoleak
  • endovascular aneurysm repair
  • translumbar embolization
  • type II endoleak

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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