When Endovascular Interventions for Endoleaks Fail

In the appropriate patient population, endovascular aortic repair (EVAR) has become the standard of care for abdominal aortic aneurysms. While the initial success rates of EVAR are very high, reinterventions occur in a significant minority of patients, most of which consist of the repair of endoleaks. When indicated, such procedures are typically performed via endovascular or percutaneous approaches; however, in certain patients, these minimally invasive repairs fail. In these patients, surgical techniques can be used to treat the endoleaks. This article describes the open surgical techniques used in the repair of endoleaks where standard endovascular techniques fail.