Endotension After Endovascular Aneurysm Repair: The Critical Impact of Age and Reintervention on Survival

Endotension (type V endoleak), a condition of continued aneurysm sac expansion without a detectable endoleak after endovascular aneurysm repair (EVAR), remains a management challenge. This study analyzes the long-term outcomes, management strategies, and risk factors for rupture in patients with endotension.

A retrospective single-center analysis of 19 patients with endotension was conducted. Patients were stratified into two management groups: conservative (n = 11) and reintervention (n = 8). Data on aneurysm characteristics, sac dynamics, interventions, and outcomes were analyzed.

The reintervention group was significantly younger than the conservative group (mean = 73.8 vs. 82.1 years, p = 0.009). The overall rupture rate was 26.3% (5/19). The conservative management group, despite comprising patients deemed unfit for intervention, had a 27.3% (3/11) rupture rate. In contrast, the reintervention group, treated primarily with relining (7/8), had a 25% (2/8) rupture rate; both cases were successfully treated emergently with 100% survival. Technical success for reintervention was 100%. Overall mortality was 36.8% (7/19). Sac progression stabilized in 40% (2/5) of anticoagulated patients following cessation of therapy.

Endotension carries a significant rupture risk, even under conservative management. A strategy of vigilant surveillance with a low threshold for reintervention in suitable candidates is critical. Endovascular relining is a highly effective and durable solution, even in emergencies.