An algorithm for diagnosis and treatment of type II endoleaks and endotension after endovascular aneurysm repair

Endoleak after endoluminal abdominal aortic aneurysm repair is a relatively common occurrence. Depending on the type of endoleak involved, treatment strategies range from continued serial observation to urgent re-intervention. Type II, or branch vessel endoleaks, are often benign in terms of their natural history but can potentially be associated with progressive abdominal aortic aneurysm sac expansion, endograft migration, or even aneurysm rupture. Type V endoleaks, also known as endotension, may represent an undiagnosed type I-IV endoleak or a progressive accumulation of transudate through the interstices of the endograft. Treatment strategies therefore hinge on correctly identifying the etiology of the endotension. We discuss the diagnosis and management of type II and V endoleaks, with a focus on a device-specific approach to endoleak treatment.