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Related Experiment Video

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Type II Endoleak After EVAR: The Sac Behavior-Anatomy Driven Management (SADM) Framework.

Maciej Błaszyk1, Zuzanna Fryska1, Jakub Waliszewski1

  • 1Department of Clinical Radiology, Poznan University of Medical Studies, Poland.

Annals of Vascular Surgery
|June 25, 2026
PubMed
Summary

Type II endoleak (T2EL) after EVAR is common but often benign. Management focuses on aneurysm sac behavior, not just T2EL presence, guiding intervention decisions.

Keywords:
EVARabdominal aortic aneurysmembolizationinterventional radiologysac enlargementtype II endoleak

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Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Aortic Aneurysm Disease

Background:

  • Type II endoleak (T2EL) is the most frequent complication post-EVAR.
  • The clinical significance of T2EL is debated, with some cases leading to aneurysm sac enlargement.

Purpose of the Study:

  • To review current evidence on T2EL diagnosis, surveillance, and management.
  • To introduce the Sac Behavior-Anatomy Driven Management (SADM) framework for T2EL decision-making.

Main Methods:

  • Comprehensive literature review on T2EL following EVAR.
  • Development and operationalization of the SADM framework integrating guidelines and anatomy.

Main Results:

  • T2EL occurs in 10-30% of EVAR patients; clinically relevant sac enlargement is less common.
  • Surveillance is guided by aneurysm sac dynamics; intervention is reserved for persistent T2EL with enlargement.
  • Endovascular embolization is the primary treatment, but evidence for specific techniques is limited.

Conclusions:

  • The SADM framework offers a practical approach to T2EL management, prioritizing aneurysm sac behavior.
  • Decision-making should separate treatment indication from procedural strategy based on sac dynamics and anatomy.