Skip to main content
SpringerLink
Log in

Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a–d
Fig. 2a–f
Fig. 3a,b
Fig. 4a,b
Fig. 5a–e

Similar content being viewed by others

References

  1. Cuypers P, Buth J, Harris PL et al (1999) Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry. Eur J Vasc Endovasc Surg 17:507–516

    Article  PubMed  CAS  Google Scholar 

  2. Parent FN, Meier GH, Godziachvili V et al (2002) The incidence and natural history of Type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg 35:474–481

    Article  PubMed  Google Scholar 

  3. Fan CM, Rafferty EA, Geller EC 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 218:176–182

    PubMed  CAS  Google Scholar 

  4. Golzarian J, Struyven J, Abada HT et al (1997) Endovascular aortic stent–grafts: transcatheter embolization of persistent perigraft leaks. Radiology 202:731–734

    PubMed  CAS  Google Scholar 

  5. 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 35:1029–1035

    Article  PubMed  Google Scholar 

  6. Malina M, Lindblad B, Ivancev K et al (1998) Endovascular AAA exclusion: will stents with hooks and barbs prevent stent–graft migration? J Endovasc Surg 5:310–317

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  8. Buth J, Harris PL, van Marrewijk C, Fransen G (2003) The significance and management of different types of endoleaks. Semin Vasc Surg 16:95–102

    PubMed  Google Scholar 

  9. Zarins CK, White RA, Hodgson KJ et al (2000) Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial. J Vasc Surg 32:90–107

    Article  PubMed  CAS  Google Scholar 

  10. 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 35:461–473

    Article  PubMed  Google Scholar 

  11. Fransen GA, Vallabhaneni SR Sr, Van Marrewijk CJ et al (2003) Rupture of infrarenal aortic aneurysm after endovascular repair: a series from EUROSTAR registry. Eur J Vasc Endovasc Surg 26:487–493

    Article  PubMed  CAS  Google Scholar 

  12. Gilling–Smith G, Brennan J, Harris P, Bakran A, Gould D, McWilliams R (1999) Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention. J Endovasc Surg 6:305–307

    Article  PubMed  CAS  Google Scholar 

  13. White GH, May W, Petrasek P, Waugh R, Stephen M, Harris J (1999) Endotension: an explanation for continued AAA growth after successful endoluminal repair. J Endovasc Surg 6:308–315

    Article  PubMed  CAS  Google Scholar 

  14. Gilling–Smith GL, Martin J, Sudhindran S et al (2000) Freedom from endoleak after endovascular aneurysm repair does not equal treatment success. Eur J Vasc Endovasc Surg 19:421–425

    Article  PubMed  CAS  Google Scholar 

  15. Meier GH, Parker FM, Godziachvili V et al (2001) Endotension after endovascular aneurysm repair: the Ancure experience. Vasc Surg 34:421–427

    Article  CAS  Google Scholar 

  16. Risberg B, Delle M, Lonn L, Syk I (2004) Management of aneurysm sac hygroma. J Endovasc Ther 11:191–195

    Article  PubMed  Google Scholar 

  17. Gawenda M, Jaschke G, Winter ST, Wassmer G, Brunkwall J (2003) Endotension as a result of pressure transmission through the graft following endovascular aneurysm repair—an in vitro study. Eur J Vasc Endovasc 26:501–505

    Article  CAS  Google Scholar 

  18. Gorich J, Rilinger N, Sokiranski R et al (1999) Leakages after endovascular repair of aortic aneurysms: classification based on findings at CT, angiography, and radiography. Radiology 213:767–772

    PubMed  CAS  Google Scholar 

  19. Gorich J, Rilinger N, Kramer S et al (2000) Angiography of leaks after endovascular repair of infrarenal aortic aneurysms. AJR Am J Roentgenol 174:811–814

    PubMed  CAS  Google Scholar 

  20. Golzarian J, Dussaussois L, Abada HT et al (1998) Helical CT of aorta after endoluminal stent–graft therapy. AJR Am J Roentgenol 171:329–331

    PubMed  CAS  Google Scholar 

  21. Rosenblit AM, Patlas M, Rosenbaum AT et al (2003) Detection of endoleaks after endovascular repair of abdominal aortic aneurysms: value of unenhanced and delayed CT acquisitions. Radiology 227:426–433

    PubMed  Google Scholar 

  22. Sawhney R, Kerlen RK, Wall SD et al (2001) Analysis of initial CT findings after endovascular repair of abdominal aortic aneurysm. Radiology 220:157–160

    PubMed  CAS  Google Scholar 

  23. Elkouri S, Panneton JM, Andrews JC et al (2004) Computed tomography and ultrasound in follow–up of patients after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg 18:271–279

    Article  PubMed  Google Scholar 

  24. Wolf YG, Johnson BL, Hill BB et al (2000) Duplex ultrasound scanning versus computed tomographic angiography for post–operative evaluation of endovascular abdominal aortic aneurysm repair. J Vasc Surg 32:1142–1148

    Article  PubMed  CAS  Google Scholar 

  25. Zannetti S, De Rango P, Parente B et al (2000) Role of duplex scan in endoleak detection after endoluminal abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 19:531–535

    Article  PubMed  CAS  Google Scholar 

  26. Pages S, Favre JP, Cerisier A et al (2001) Comparison of color duplex ultrasound and computed tomography scan for surveillance after aortic endografting. Ann Vasc Surg 15:155–162

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  28. McWilliams RG, Martin J, White D et al (2002) Detection of endoleak with enhanced ultrasound imaging: comparison with biphasic computed tomography. J Endovasc Ther 9:170–179

    Article  PubMed  Google Scholar 

  29. McLafferty RB, McCrary BS, Mattos MA et al (2002) The use of color–flow duplex scan for the detection of endoleaks. J Vasc Surg 36:100–104

    Article  PubMed  Google Scholar 

  30. Raman KG, Missing–Carroll N, Richardson T et al (2003) Color–flow duplex ultrasound scan versus computed tomographic scan in the surveillance of endovascular aneurysm repair. J Vasc Surg 38:645–651

    Article  PubMed  Google Scholar 

  31. Bendick PJ, Bove PG, Long GW et al (2003) Efficacy of ultrasound scan contrast agents in the noninvasive follow–up of aortic stent grafts. J Vasc Surg 37:381–385

    Article  PubMed  Google Scholar 

  32. Napoli V, Bargellini I, Sardella SG et al (2004) Abdominal aortic aneurysm: contrast–enhanced US for missed endoleaks after endoluminal repair. Radiology 233:217–225

    PubMed  Google Scholar 

  33. Haulon S, Lions C, McFadden EP, Koussa M et al (1998) Prospective evaluation of magnetic resonance imaging after endovascular treatment of infrarenal aortic aneurysms. Eur J Endovasc Surg 22:62–69

    Article  Google Scholar 

  34. Ayuso JR, de Caralt TM, Pages M, Riambau V et al (2004) MRA is useful as a follow–up technique after endovascular repair of aortic aneurysms with nitinol endoprostheses J Magn Reson. Imaging 20:803–810

    Google Scholar 

  35. Cejna M, Loewe C, Schoder M et al (2002) MR angiography vs CT angiography in the follow–up of Nitinol stent grafts in the endoluminally treated aortic aneurysms. Eur Radiology 12:2443–2450

    Google Scholar 

  36. Lutz AM, Willmann JK, Pfammatter T, Lachat M (2003) Evaluation of aortoiliac aneurysm before endovascular repair: comparison of contrast–enhanced magnetic resonance angiography with multidetector row computed tomographic angiography with an auotmated analysis software tool. J Vasc Surg 37:619–627

    Article  PubMed  Google Scholar 

  37. Ersoy H, Jacobs P, Kent KK, Prince MR (2004) Blood pool MR Angiography of aortic stentgraft endoleak. AJR Am J Roentgenol 182:1181–1186

    PubMed  Google Scholar 

  38. Lookstein RA, Goldman J, Pukin L, Marin ML (2004) Time–resolved magnetic resonance angiography as a noninvasive method to characterize endoleaks: initial results compared with conventional angiography. J Vasc Surg 39:27–33

    Article  PubMed  Google Scholar 

  39. Hellinger JC, Draney M, Markl M, Pelc NJ et al (2003) Application of cine phase contrast magnetic resonance imaging and SPAMM–tagging for assessment of endoleaks and aneurysm sac motion. Radiology 229:SS 573 (Abstract)

    Google Scholar 

  40. Amesur NB, Zajko AB, Orons PD, Makaroun MS (1999) Embolotherapy of persistent endoleaks after endovascular repair of abdominal aortic aneurysm with the ancure–endovascular technologies endograft system. J Vasc Interv Radiol 10:1175–1182

    Article  PubMed  CAS  Google Scholar 

  41. Gorich J, Rilinger N, Sokiranski R et al (2000) Treatment of leaks after endovascular repair of aortic aneurysms. Radiology 215:414–420

    PubMed  CAS  Google Scholar 

  42. Faries PL, Cadot H, Agarwal G et al (2003) Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. J Vasc Surg 37:1155–1161

    Article  PubMed  Google Scholar 

  43. Sheehan M, Barbato J, Compton NC et al (2004) Effectiveness of coiling in the treatment of endoleak after endovascular repair. J Vasc Surg 40:430–434

    Article  PubMed  Google Scholar 

  44. Baum RA, Stavropoulos SW, Fairman RM, Carpenter JP (2003) Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 14:1111–1117

    PubMed  Google Scholar 

  45. 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 

  46. Martin ML, Dolmatch BL, Fry PD, Machan LS (2001) Treatment of Type II endoleaks with Onyx. J Vasc Interv Radiol 2:629–632

    Google Scholar 

  47. Schmid R, Gurke L, Aschwanden M et al (2002) CT–guided percutaneous embolization of a lumbar artery maintaining a Type II endoleak. J Endovasc Ther 9:198–202

    Article  PubMed  Google Scholar 

  48. van den Berg JC, Nolthenius RP, Casparie JW et al (2000) CT–guided thrombin injection into aneurysm sac in a patient with endoleak after endovascular abdominal aortic aneurysm repair. AJR Am J Roentgenol 175:1649–1651

    PubMed  Google Scholar 

  49. Ellis PK, Kennedy PT, Collins AJ, Blair PH (2003) The use of direct thrombin injection to treat a Type II endoleak following endovascular repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol 26:482–484

    Article  Google Scholar 

  50. Gambaro E, Abou–Zamzam AM Jr, Teruya TH et al (2004) Ischemic colitis following translumbar thrombin injection for treatment of endoleak. Ann Vasc Surg 18:74–78

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  52. Thoo CHC, Bourke BM, May J (2004) Symptomatic sac enlargement and rupture due to seroma after open abdominal aortic aneurysm repair with polytetrafluoroethylene graft: Implications for endovascular repair and Endotension. J Vasc Surg 40:1089–1094

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Iowa Heath Care, University of Iowa, 200 Hawkins Drive, Iowa, 52242, USA

    Jafar Golzarian

  2. Royal Victoria Hospital, McGill University Health Centre, McGill University, 687 Pine Avenue West, Suite A451, Montreal, H3A 1A1, Canada

    David Valenti

Authors
  1. Jafar Golzarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Valenti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jafar Golzarian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Golzarian, J., Valenti, D. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment. Eur Radiol 16, 2849–2857 (2006). https://doi.org/10.1007/s00330-005-0129-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-005-0129-6

Keywords

Search

Navigation