This problem has been addressed in newer stent-graft designs simply by extending the junctional overlapping zones. In these stent-graft designs, the overlapping zones at the junctions were too short. With early modular stent-graft designs, junctional separations were observed and resulted in type III ELs (Figs. Again, this can be a reason for wire fracture and perforation of the fabric material. Eventually, remodeling of the aneurysm may occur and lead to increased bending of the graft. Stent-graft distortion may also lead to a type III EL. Over time, stent wires may break, and holes can develop in the fabric material. The stent-graft is under constant mechanical microstress caused by the steady impact of arterial pulsation. Typically these types of ELs occur during long-term follow-up and are due to some type of fatigue of the fabric material or fracture of the stent component, or both. Type III ELs: Type III ELs are caused by graft failure.An inflow/outflow situation thus occurs, the typical feature of a type II EL. In contrast, left lumbar artery showed antegrade flow (arrows). Lumbar artery is perfused in a retrograde fashion (arrows). This artery communicates with right lumbar artery at the L5 level. J Vasc Surg 2002 35:474–81.)įIGURE 50-2 Angiography 18 months after endovascular repair shows a typical type II endoleak (EL) being fed by right iliolumbar artery. The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Interv Radiol 2003 14:1111–7 and Parent FN, Meier GH, Godziachvili V, et al. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2002 35:1029–35 Baum RA, Stavropoulos SW, Fairman RM, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. (Modified from Veith FJ, Baum RA, Ohki T, et al. Type II EL proven at surgery, not shown during follow-up imaging Type I or III EL proven at surgery, not shown during follow-up imaging Sac enlargement, currently no EL discernible, but type I or II EL in previous examinations Sac enlargement without demonstration of EL with any imaging modality The clinical significance and possible treatment options are also covered here.

3 In this chapter, the different types of ELs are described and the most rational imaging strategies for the diagnosis of ELs are discussed. This phenomenon has been coined endoleak (EL) by White et al. Unlike open repair, perigraft blood flow outside the endoprosthesis but inside the aneurysm sac may occur after EVAR. In any case, tight sutures and hemostasis must be achieved primarily. Arterial side branches originating from the aneurysmal sac, such as the inferior mesenteric artery (IMA), lumbar arteries, and accessory renal arteries, are either surgically ligated or reanastomosed to the surgical graft if necessary. A surgical graft is sewn in with a tight suture at the proximal and distal ends of the aneurysm. In traditional open surgical repair, the aneurysm is excluded from the arterial circulation under direct visualization. 1, 2 However, despite similar results regarding rupture and survival rates, these treatment concepts have fundamental differences. Two recently published prospective trials have shown that EVAR of AAAs produces clinical results similar to those of open surgery after observation periods of 6 and 10 years, respectively, with EVAR having an advantage in postoperative mortality and morbidity. Endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA) has become a widespread procedure of late.

Type 3 endoleak