Skip to main content
Log in

Quality Improvement Guidelines for Imaging Detection and Treatment of Endoleaks following Endovascular Aneurysm Repair (EVAR)

  • CIRSE Standards of Practice Guidelines
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Veith FJ, Baum RA, Ohki T et al (2002) Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 35(5):1029–1035

    Article  PubMed  Google Scholar 

  2. Solis MM, Ayerdi J, Babcock GA et al (2002) Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization. J Vasc Surg 36(3):485–491

    Article  PubMed  Google Scholar 

  3. Harris PL, Dimitri S (1999) Predicting failure of endovascular aneurysm repair. Eur J Vasc Endovasc Surg 17(1):1–2

    Article  PubMed  CAS  Google Scholar 

  4. van Marrewijk CJ, Fransen G et al EUROSTAR Collaborators (2004) Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg 27(2):128–137

  5. Cao P, De Rango P, Verzini F et al (2010) Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair. J Cardiovasc Surg 51:53–69

    CAS  Google Scholar 

  6. Van Bindsbergen L, Braak SJ, van Strijen MJ et al (2010) Type II endoleak embolization after endovascular abdominal aortic aneurysm repair with use of real-time three-dimensional fluoroscopic needle guidance. J Vasc Interv Radiol 21:1443–1447

    Article  PubMed  Google Scholar 

  7. Buth J, Laheij RJ (2000) Early complications and endoleaks after endovascular abdominal aortic aneurysm repair: report of a multicenter study. J Vasc Surg 31:134–146

    Article  PubMed  CAS  Google Scholar 

  8. van Marrewijk C, Buth J, Harris PL et al (2002) Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience. J Vasc Surg 35(3):461–473

    Article  PubMed  Google Scholar 

  9. Liaw JV, Clark M, Gibbs R et al (2009) Update: complications and management of infrarenal EVAR. Eur J Radiol 71(3):541–551

    Article  PubMed  CAS  Google Scholar 

  10. White GH, Yu W, May J et al (1997) Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 4(2):152–168

    Article  PubMed  CAS  Google Scholar 

  11. Rosen RJ, Green RM (2008) Endoleak management following endovascular aneurysm repair. J Vasc Interv Radiol 19:S37–S43

    Article  PubMed  Google Scholar 

  12. Moll FL, Powell JT, Fraedrich G et al (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 41:S1–S58

    Article  PubMed  Google Scholar 

  13. Baum RA, Stavropoulos SW et al (2003) Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 14:1111–1117

    Article  PubMed  Google Scholar 

  14. Baum RA, Carpenter JP, Tuite CM et al (2000) Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms. Radiology 215(2):409–413

    PubMed  CAS  Google Scholar 

  15. Silverberg D, Baril DT, Ellozy SH et al (2006) An 8-year experience with type II endoleaks: natural history suggests selective intervention is a safe approach. J Vasc Surg 44(3):453–459

    Article  PubMed  Google Scholar 

  16. Cynamon J, Federman AS, Veith FJ (1999) Repair of junctional stent-graft leaks with use of a bare metal stent. J Vasc Interv Radiol 10(3):275–280

    Article  PubMed  CAS  Google Scholar 

  17. Heikkinen MA, Arko FR, Zarins CK (2004) What is the significance of endoleaks and endotension. Surg Clin N Am 84(5):1337–1352

    Article  PubMed  Google Scholar 

  18. Gilling-Smith G, Brennan J, Harris P et al (1999) Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention. J Endovasc Surg 6(4):305–307

    Article  PubMed  CAS  Google Scholar 

  19. Shah A, Stavropoulos SW (2009) Imaging surveillance following endovascular aneurysm repair. Semin Interv Radiol 26:10–16

    Article  Google Scholar 

  20. Drury D, Michaels JA, Jones L et al (2005) Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br J Surg 92:937–946

    Article  PubMed  CAS  Google Scholar 

  21. Baum RA, Carpenter JP, Golden MA et al (2002) Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques. J Vasc Surg 35:23–29

    PubMed  Google Scholar 

  22. Solis MM, Ayerdi J, Babcock GA et al (2002) Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization. J Vasc Surg 36:485–491

    Article  PubMed  Google Scholar 

  23. Springer F, Günther RW, Schmitz-Rode T (2008) Aneurysm sac pressure measurement with minimally invasive implantable pressure sensors: an alternative to current surveillance regimes after EVAR? Cardiovasc Interv Radiol 31:460–467

    Article  Google Scholar 

  24. Dias NV, Ivancec K, Malina M et al (2004) Intra-aneurysm sac pressure measurements after endovascular aneurysm repair: differences between shrinking, unchanged, and expanding aneurysms with and without endoleaks. J Vasc Surg 39:1229–1235

    Article  PubMed  Google Scholar 

  25. Baum RA, Carpenter JP, Cope C et al (2001) Aneurysm sac pressure measurements after endovascular repair or abdominal aortic aneurysms. J Vasc Surg 33:32–41

    Article  PubMed  CAS  Google Scholar 

  26. Nordon IM, Karthikesalingam A, Hinchcliffe RJ et al (2010) Secondary interventions following endovascular aneurysm repair (EVAR) and the enduring value of graft surveillance. Eur J Vasc Endovasc Surg 39:547–554

    Article  PubMed  CAS  Google Scholar 

  27. Stavropoulos SW, Charagundla SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 243(3):641–655

    Article  PubMed  Google Scholar 

  28. Fan CM, Rafferty EA, Geller SC et al (2001) Endovascular stent-graft in abdominal aortic aneurysms: the relationship between patent vessels that arise from the aneurysmal sac and early endoleak. Radiology 218(1):176–182

    PubMed  CAS  Google Scholar 

  29. Iezzi R, Cotroneo AR, Filippone A et al (2008) Multidetector-row computed tomography angiography in abdominal aortic aneurysm treated with endovascular repair: evaluation of optimal timing of delayed phase imaging for the detection of low-flow endoleaks. J Comput Assist Tomogr 32(4):609–615

    Article  PubMed  Google Scholar 

  30. Van der Laan MJ, Bartels LW, Viergever MA et al (2006) Computed tomography versus magnetic resonance imaging of endoleaks after EVAR. Eur J Vasc Endovasc Surg 32(4):361–365

    Article  PubMed  Google Scholar 

  31. Henao EA, Hodge MD, Felkai DD et al (2006) Contrast enhanced duplex surveillance after endovascular abdominal aortic aneurysm repair: improved efficacy using a continuous infusion technique. J Vasc Surg 43:259–264

    Article  PubMed  Google Scholar 

  32. Golzarian J, Murgo S, Dussaussois L (2002) Evaluation of abdominal aortic aneurysm after endoluminal treatment: comparison of colour Doppler sonography with biphasic helical CT. AJR Am J Roentgenol 178(3):623–628

    PubMed  Google Scholar 

  33. Bakken AM, Illig KA (2010) Long-term follow-up after endovascular aneurysm repair: is ultrasound alone enough? Perspect Vasc Surg Endovasc Ther 22(3):145–151

    Article  PubMed  Google Scholar 

  34. Gorlitzer M, Mertikian G, Trnka H et al (2008) Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm. Interact Cardiovasc Thorac Surg 7(5):781–784

    Article  PubMed  Google Scholar 

  35. Sternbergh WC, Greenberg RK, Chuter TA et al (2008) Redefining postoperative surveillance after endovascular aneurysm repair: recommendations based on 5-year follow-up in the US Zenith multicenter trial. J Vasc Surg 48:278–284

    Article  PubMed  Google Scholar 

  36. Pitton MB, Schweitzer H, Herber S et al (2005) MRI versus helical CT for endoleak detection after endovascular aneurysm repair. AJR Am J Roentgenol 185(5):1275–1281

    Article  PubMed  Google Scholar 

  37. Schwope RB, Alper HJ, Talenfeld AD et al (2007) MR angiography for patient surveillance after endovascular repair of abdominal aortic aneurysms. AJR Am J Roentgenol 188:334–340

    Article  Google Scholar 

  38. Cornelissen SA, Prokop M, Verhagen HJ et al (2010) Detection of occult endoleaks after endovascular treatment of abdominal aortic aneurysm using magnetic resonance imaging with a blood pool contrast agent: preliminary observations. Invest Radiol 45(9):548–553

    Article  PubMed  CAS  Google Scholar 

  39. Steinmetz E, Rubin BG, Sanchez LA et al (2004) Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost effective. J Vasc Surg 39:306–313

    Article  PubMed  Google Scholar 

  40. EVAR trial participants (2005) Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 25:2187–2192

    Google Scholar 

  41. Ricco JB, Goëau-Brissonnière O, Rodde-Dunet MH et al (2003) Use of abdominal aortic endovascular prostheses in France from 1999 to 2001. J Vasc Surg 38(6):1273–1281

    Article  PubMed  Google Scholar 

  42. Hobo R, Buth J, EUROSTAR collaborators (2006) Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. J Vasc Surg 43(5):896–902

    Article  PubMed  Google Scholar 

  43. Cao P, De Rango P, Parlani G et al (2009) Durability of abdominal aortic endograft with the Talent Unidoc stent graft in common practice: core lab reanalysis from the TAURIS multicenter study. J Vasc Surg 49(4):859–865

    Article  PubMed  Google Scholar 

  44. Criado FJ, Fairman RM, Becker GJ et al (2003) Talent LPS AAA stent graft: results of a pivotal clinical trial. J Vasc Surg 37(4):709–710

    Article  PubMed  Google Scholar 

  45. Elkouri S, Gloviczki P, McKusick MA et al (2003) Endovascular repair of abdominal aortic aneurysms: initial experience with 100 consecutive patients. Mayo Clin Proc 78(10):1234–1242

    Article  PubMed  Google Scholar 

  46. Flora HS, Chaloner EJ, Sweeney A et al (2003) Secondary intervention following endovascular repair of abdominal aortic aneurysm: a single centre experience. Eur J Vasc Endovasc Surg 26(3):287–292

    Article  PubMed  CAS  Google Scholar 

  47. Carpenter JP, Endologix Investigators (2004) Midterm results of the multicenter trial of the powerlink bifurcated system for endovascular aortic aneurysm repair. J Vasc Surg 40(5):849–859

    Article  PubMed  Google Scholar 

  48. Lalka S, Dalsing M, Cikrit D et al (2005) Secondary interventions after endovascular abdominal aortic aneurysm repair. Am J Surg 190(5):787–794

    Article  PubMed  Google Scholar 

  49. Hiramoto JS, Reilly LM, Schneider DB et al (2007) Long-term outcome and reintervention after endovascular abdominal aortic aneurysm repair using the Zenith stent graft. J Vasc Surg 45(3):461–465

    Article  PubMed  Google Scholar 

  50. Abbruzzese TA, Kwolek CJ, Brewster DC et al (2008) Outcomes following endovascular abdominal aortic aneurysm repair (EVAR): an anatomic and device-specific analysis. J Vasc Surg 48:19–28

    Article  PubMed  Google Scholar 

  51. Smith S, Mountcastle S, Burridge A et al (2008) A single-institution experience with the AneuRx stent graft for endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg 22:221–226

    Article  PubMed  Google Scholar 

  52. Traul D, Street D, Faught W, Eaton M et al (2008) Endoluminal stent-graft placement for repair of abdominal aortic aneurysms in the community setting. J Endovasc Ther 15:688–694

    Article  PubMed  Google Scholar 

  53. Black SA, Carrell TW, Bell RE et al (2009) Long-term surveillance with computed tomography after endovascular aneurysm repair may not be justified. Br J Surg 96:1280–1283

    Article  PubMed  CAS  Google Scholar 

  54. Espinosa G, Ribeiro Alves M et al (2009) A 10-year single-center prospective study of endovascular abdominal aortic aneurysm repair with the talent stent-graft. J Endovasc Ther 16:125–135

    Article  PubMed  Google Scholar 

  55. Jean-Baptiste E, Batt M, Azzaoui R et al (2009) A comparison of the mid-term results following the use of bifurcated and aorto-uni-iliac devices in the treatment of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 38(3):298–304

    Article  PubMed  CAS  Google Scholar 

  56. Pitoulias GA, Schulte S, Donas KP et al (2009) Secondary endovascular and conversion procedures for failed endovascular abdominal aortic aneurysm repair: can we still be optimistic? Vascular 17(1):15–22

    Article  PubMed  Google Scholar 

  57. Conrad MF, Adams AB, Guest JM et al (2009) Secondary intervention after endovascular abdominal aortic aneurysm repair. Ann Surg 250(3):383–389

    PubMed  Google Scholar 

  58. Rosen RJ, Green RM (2008) Endoleak management following endovascular aneurysm repair. J Vasc Interv Radiol 19:37–43

    Article  Google Scholar 

  59. Sheehan MK, Barbato J, Compton CN et al (2004) Effectiveness of coiling in the treatment of endoleaks after endovascular repair. J Vasc Surg 40(3):430–434

    Article  PubMed  Google Scholar 

  60. Schoder M, Zaunbauer L, Hölzenbein T et al (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: frequency, efficacy, and clinical results. AJR Am J Roentgenol 177(3):599–605

    PubMed  CAS  Google Scholar 

  61. Bratby MJ, Munneke GM, Belli AM et al (2008) How safe is bilateral internal iliac artery embolization prior to EVAR? Cardiovasc Interv Radiol 31:246–253

    Article  CAS  Google Scholar 

  62. Gould DA, McWilliams R, Edwards RD et al (2001) Aortic side branch embolization before endovascular aneurysm repair: incidence of type II endoleak. J Vasc Interv Radiol 12:337–341

    Article  PubMed  CAS  Google Scholar 

  63. Axelrod DJ, Lookstein RA, Guller J et al (2004) Inferior mesenteric artery embolization before endovascular aneurysm repair: technique and initial results. J Vasc Interv Radiol 15:1263–1267

    Article  PubMed  Google Scholar 

  64. Bonvini R, Alerci M, Antonucci F (2003) Preoperative embolization of collateral side branches: a valid means to reduce type II endoleaks after endovascular AAA repair. J Endovasc Ther 10(2):227–232

    Article  PubMed  Google Scholar 

  65. Görich J, Rilinger N, Sokiranski R et al (2001) Endoleaks after endovascular repair of aortic aneurysm: are they predictable?. Initial results. Radiology 218(2):477–480

    PubMed  Google Scholar 

  66. Wisselink W, Cuesta MA, Berends FJ et al (2000) Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair. J Vasc Surg 31:1240–1244

    Article  PubMed  CAS  Google Scholar 

  67. Richardson WS, Sternbergh WC 3rd, Money SR (2003) Laparoscopic inferior mesenteric artery ligation: an alternative for the treatment of type II endoleaks. J Laparoendosc Adv Surg Tech A 13(6):355–358

    Article  PubMed  Google Scholar 

  68. Ellis PK, Kennedy PT, Collins AJ et al (2003) The use of direct thrombin injection to treat a type II endoleak following endovascular repair of abdominal aortic aneurysm. Cardiovasc Interv Radiol 26(5):482–484

    Article  Google Scholar 

  69. Stavropoulos SW, Carpenter JP, Fairman RM et al (2003) Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol 14(9):1191–1194

    Article  PubMed  Google Scholar 

  70. Barbiero G, Baratto A, Ferro F et al (2008) Strategies of endoleak management following endoluminal treatment of abdominal aortic aneurysm in 95 patients: how, when and why. Radiol Med 113(7):1029–1042

    Article  PubMed  CAS  Google Scholar 

  71. Kasthuri RS, Stivaros SM, Gavan D (2005) Percutaneous ultrasound-guided thrombin injection for endoleaks: an alternative. CVIR 28(1):110–112

    Article  PubMed  Google Scholar 

  72. Trocciola SM, Dayal R, Chaer RA et al (2006) The development of endotension is associated with increased transmission of pressure and serous components in porous expanded polytetrafluoroethylene stent-grafts: characterization using a canine model. J Vasc Surg 43(1):109–116

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T. Rand.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rand, T., Uberoi, R., Cil, B. et al. Quality Improvement Guidelines for Imaging Detection and Treatment of Endoleaks following Endovascular Aneurysm Repair (EVAR). Cardiovasc Intervent Radiol 36, 35–45 (2013). https://doi.org/10.1007/s00270-012-0439-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-012-0439-4

Keywords

Navigation