Endoleak following abdominal aneurysm (AAA) repair

Endoleak in aortic abdominal aneurysm repair:

The persistence of blood flow outside an endovascular stent–graft but within the aneurysm sac in which the graft is placed. There are 5 types of endoleak:

• Type 1 – blood flowing into the aneurysm because of an incomplete or ineffective seal at either end of a stent–graft

• Type 2 – blood flowing into an AAA from side branches of the aorta

• Type 3 – blood flowing into an AAA through defects in the endograft

• Type 4 – blood flowing through the stent–graft fabric into an AAA

• Type 5 – continued AAA expansion without radiographic evidence of a leak site.

Investigation:

• use contrast-enhanced CT angiography if an endoleak is suspected. If contrast-enhanced CT angiography is contraindicated, use contrast-enhanced ultrasound
  • do not exclude endoleaks based on a negative colour duplex ultrasound alone in people who have had endovascular aneurysm repair (EVAR)

Managing endoleaks after endovascular aneurysm repair

• consider open, endovascular or percutaneous intervention for type 1 and type 3 endoleaks following EVAR
• consider intervention for type 2 endoleaks in people who have abdominal aortic aneurysm (AAA) expansion following EVAR
• consider further investigation of type 5 endoleaks following EVAR

Reference:

• NICE (March 2020).Abdominal aortic aneurysm: diagnosis and management