Treatment of endoleaks: techniques and outcome

Endoleaks are one of the most common reasons for reinterventions and failure after endovascular aneurysm repair (EVAR). Current classifications divide endoleaks into type I-V but a more pragmatic definition is of direct and indirect endoleaks. Direct endoleaks (type I and III) transmit direct systemic pressure to the aneurysm sac and carry a high risk of aneurysm growth and rupture if left untreated. Immediate intervention is generally warranted. Indirect endoleaks (type II, IV, V) may have a more benign course and should be treated only under the presence of aneurysm growth. Appropriate procedural planning and device selection is critical to avoid endoleaks and most direct endoleaks can be identified and treated periprocedurally by use of high quality intraoperative imaging techniques. Late endoleaks can be treated predominately by endovascular means and the need for conversion to open surgery is rare.