Endoleaks

Abdominal aortic aneurysms are characterized by an abnormal expansion of the arterial wall due to weakening and are present in approximately 1 in 20 adults. The leading risk factors for abdominal aortic aneurysm are smoking history, advanced age, and male gender. If left untreated, there is an increased risk of rupture, especially after reaching more than 5.5 cm in diameter. Most infrarenal abdominal aortic aneurysms are treated with endografts. The most common complication encountered with endografts is an endoleak, a term which defines the persistence of blood flow within the aneurysm sac. This occurs in up to half of patients undergoing endovascular repair. Endoleaks can be recognized at the time of endograft deployment with digital subtraction angiography or on follow-up surveillance examinations. CT angiography is the most commonly performed imaging follow-up, but duplex ultrasound and MRI can also be used. The former is mostly for monitoring size while the latter is mostly a problem-solving tool. Treatment of endoleaks varies by type. Whereas types 1 and 3 mandate treatment, other types of endoleaks can be observed and treated only if there is interval aneurysm sac enlargement.