[The endoleak problem in endoluminal therapy]

Endovascular treatment of aortic aneurysms with stent grafts was performed increasingly in recent years. The most frequent complication after endovascular therapy of aortic aneurysms is an endoleak. In case of a persistent endoleak, diameter of the aneurysm is increasing with a high risk of aneurysm ruptur. Diagnostic tools are spiral computed tomography and angiography. Spiral computed tomography is the most sensitive method for the diagnosis of an endoleak ad should be performed with a biphasic acquisition. In- and outflow of sidebranches can be identified correctly with selective angiography in 86%. Perigraft endoleaks should be treated in any case. Patent side branches generally are observed over a period of 6 months. After 6 months approximately half of these endoleaks are thrombosed. Is there an increasing of the diameter of the aneurysm or any changing in the morphology of the aneurysm there is an indication for embolisation of these sidebranches of the aneurysmal sac. Preinterventional embolisation of patent sidebranches is under discussion. Type I endoleaks can be managed by additional stent-graft implantation or coil embolisation. In case of type II endoleaks in- ad outflow vessels should be embolised with coils. Therapy of type III endoleak is performed mostly by additional stent-graft placement. The total incidence of secondary interventions in the Eurostar-study was nearly 10% per year.