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

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Endovascular aneurysm repair (EVAR) is preferred for abdominal aortic aneurysms due to lower mortality and complication rates compared to open repair.
• Endoleak, a persistent leak after EVAR, is a known complication.
• Type II endoleaks are the most common, originating from collateral arteries like lumbar or inferior mesenteric arteries.

Purpose of the Study:

• To outline a protocol for imaging surveillance after EVAR.
• To discuss various treatment strategies for type II endoleaks.
• To highlight the potential risks associated with type II endoleaks, including aneurysm sac pressurization and rupture.

Main Methods:

• Review of post-EVAR imaging surveillance protocols.
• Discussion of endoleak treatment modalities: transarterial, translumbar, transcaval, perigraft, and open surgery.
• Analysis of the etiology and natural history of type II endoleaks.

Main Results:

• Type II endoleaks are the most frequent type of endoleak post-EVAR.
• Spontaneous resolution of type II endoleaks occurs within 6 months in many cases.
• Despite potential for spontaneous resolution, type II endoleaks can lead to aneurysm sac pressurization and rupture risk.

Conclusions:

• A structured surveillance protocol is essential for monitoring EVAR patients.
• Intervention for type II endoleaks should be considered when spontaneous resolution is unlikely or risks are high.
• Multiple treatment options exist for type II endoleaks, tailored to individual patient anatomy and risk factors.