Endovascular Treatment of a Multimorbid Patient With Late AAA Rupture After Stent-Graft Placement:1-year Follow-up

Imaging Techniques for Detection and Management of Endoleaks after Endovascular Aortic Aneurysm Repair1

Endovascular aortic aneurysm repair (EVAR) is evolving into a viable alternative to open surgical repair for many patients with abdominal and thoracic aortic aneurysms. Endoleak development is a complication of EVAR and represents one of the limitations of this procedure. Endoleaks represent blood flow outside the stent-graft lumen but within the aneurysm sac. Lifelong imaging surveillance of patients after EVAR is critical to detect endoleaks for the patient's benefit and to determine the long-term performance of the stent-graft. Although computed tomographic angiography is the most commonly used examination for imaging surveillance, magnetic resonance angiography, ultrasonography, and digital subtraction angiography all have a role in endoleak detection and management. This review will focus on imaging techniques used for endoleak detection and the role imaging surveillance plays in the overall care of the post-EVAR patient.

Imaging modalities for the detection and management of endoleaks

Although endovascular aneurysm repair (EVAR) has shown promising initial results, there are unique complications to this procedure. Endoleaks, which do not occur after traditional surgical repair of abdominal aortic aneurysms, are detected in patients undergoing EVAR and are thought by some to be one of the limitations of this procedure. Endoleaks may continue to perfuse and pressurize the aneurysm sac, thereby conferring an ongoing risk of aneurysm enlargement and/or rupture. Because of this, accurate endoleak detection and classification is essential following EVAR. Surveillance of patients is critical to determine the long-term performance of the stent grafts. Although this is usually accomplished with contrast-enhanced spiral computed tomography scans performed at regular intervals, duplex ultrasonography exams; magnetic resonance angiography; and digital subtraction angiography all have a role in endoleak detection and classification. This article will cover imaging modalities used to detect endoleaks. In addition, we will cover which imaging exams should be performed to help with endoleak management.

Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms

Endovascular repair of abdominal aortic aneurysms shows promising initial results. Endoleaks represent one of the unique causes of endovascular repair failure not seen with traditional abdominal aortic aneurysm repair. Endoleaks occur when there is blood flow outside the stent-graft lumen but within the aneurysm sac. They can be difficult to diagnose and treat, and their management is a source of continued controversy. This review further defines endoleaks and the clinical challenges that they create. Current methods for endoleak detection, classification, and management are reviewed.