Type II endoleaks: challenges and solutions

Figures & data

Figure 1 Duplex image showing type II endoleak entering aneurysm sac post-EVAR (arrow).

Abbreviation: EVAR, endovascular abdominal aortic aneurysm repair.

Table 1 Classification of endoleaks

Type of endoleak	Definition
Type I endoleak	Failure to create an adequate circumferential seal
	• Ia – proximal attachment site
	• Ib – distal attachment site
	• Ic – common iliac artery
Type II endoleak	Backflow of blood from aortic collaterals into the aneurysmal sac
Type III endoleak	Endoleak secondary to structural failure of endograft
	• IIIa – component disconnection
	• IIIb – stent fabric disturbance
Type IV endoleak	Related to graft fabric porosity
Type V endoleak (endotension)	Continued high intrasac pressure following EVAR without evidence of continued aneurysm sac perfusion

Abbreviation: EVAR, endovascular abdominal aortic aneurysm repair.

Table 2 Classification of type II endoleak

Type II endoleak classification
Early	Occurring within 30 days of EVAR
Late	Occurring after 1 year of EVAR
Persistent	Present for more than 6 months after EVAR

Abbreviation: EVAR, endovascular abdominal aortic aneurysm repair.

Figure 2 Reconstructed computed tomography demonstrating two type II endoleaks (arrow) seen as a blush anterior to the aortic stent graft.

Table 3 Risk factors versus protective factors for type II endoleak

Protective factors	Risk factors
Smoking	Patent lumbar arteries
Peripheral vascular disease	Diameter of lumbar arteries
	Patent inferior mesenteric artery
	Proportion of aneurysm sac lined with thrombus
	Maximum thrombus thickness
	Older age (>80 years)

Table 4 Classes of embolents

Embolent	Mechanism of action
Coils	Reduce blood flow inducing thrombosis Cause vessel wall damage
Amplatzer Vascular Plug	Plug the vessel wall, damaging the wall and promoting thrombogenesis
Particulate embolization agents	Reduce blood flow, initiating thrombosis and promoting angionecrosis of the vessel wall
Gelatin foam/powder	Forms a cast of the vessel forming a surface for thrombogenesis and occlusion
Tissue adhesives (glue)	Forms a cast of the vessel and incites an inflammatory response
Sclerosing agents	Directly toxic to the tissues, inducing tissue necrosis

Figure 3 Proposed management of type II endoleak.

Abbreviation: EVAR, endovascular abdominal aortic aneurysm repair.