AAA Endoleak Repair
What is an Endoleak?
During endovascular aneurysm repair (EVAR), a fabric-covered stent (stent graft) is put in place to reinforce the areas of the aorta that are weak due to an aneurysm. The stent provides a new path for blood flow, which keeps blood from reaching the aneurysm.
An endoleak is a complication that affects about 15-25% of patients who have EVAR. It means that some amount of blood flow still remains in the aneurysm cavity.
How is an Endoleak Diagnosed?
Imaging studies, such as CT scans, ultrasounds and MRIs, are done during and after an EVAR procedure. These tests show if the procedure was successful and if the stent graft is in place and working. They also show any leaks around the stent. An angiogram is done at the end of the procedure which usually allows the proceduralist to see Type I, III and sometimes Type II endoleaks. Post operative imaging modalities like CT and US should be performed for the life of the endograft as it is possible for endoleaks to develop in a delayed fashion. Your doctor will let you know how often you need to come in for imaging tests.
Types of Endoleaks
There are several types of endoleaks, classified as types I to V. Type II are the most common and are treatable through endovascular, minimally invasive techniques. Type II endoleaks occur when blood flows into the aneurysm sac from branches of the aorta, or other blood vessel treated with a stent. The blood flows into the aneurysm sac cavity through small branches which enter the treated aneurysm.
Treatment of Type II Endoleak
Type II endoleaks sometimes stop without treatment. This happens if the branches of the blood vessels that are leaking clot off and stop sending blood to the aneurysm. If this is the case, you will need imaging tests on a regular basis to watch for changes.If the leak does not stop and causes the aneurysm to get bigger, treatment to close-off the blood vessels may include:
- Use of a special glue-like material to stop the bleeding
- Metallic coils to plug the small branches which enter the aneurysm
If the graft cannot be repaired with endovascular technique, you may need referral to a surgeon to repair the graft.