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Published on: December 9, 2021
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, Poznan, Poland.
Annals of Vascular Surgery
|June 25, 2026
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.
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.
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