Evar Flashcards
(34 cards)
What is an endoleak?
Persistent perigraft blood flow within the aneurysm sac with contrast opacification changing in degree and shape between arterial and delayed phases.
Type I Endoleak
Leakage from the attachment sites of the stent-graft and native artery. Subtypes: Ia (proximal), Ib (distal), Ic (iliac occluder)
Type I Endoleak Severity
High risk. Requires urgent intervention due to direct communication with systemic pressure. High risk of aneurysm rupture if left untreated.
Type Ia Endoleak
Leakage at the proximal attachment site. Often due to short, angulated, or tapered proximal necks.
Type Ia Endoleak Management
Usually requires prompt endovascular repair. May need additional stent placement, balloon angioplasty, or in severe cases, open surgical repair.
Type Ib Endoleak
Leakage at the distal attachment site. Often due to dilated, irregular, or tortuous iliac arteries.
Type Ib Endoleak Management
Often managed with distal extension of the graft or embolization. May require open surgical repair if endovascular approach fails.
Type Ic Endoleak
Failure of occlusion of the contralateral common iliac artery in patients with aorto-uniliac endograft and femoral-femoral bypass.
Type II Endoleak
Retrograde blood flow via collateral vessels (most commonly inferior mesenteric artery and lumbar arteries). Subtypes: IIa (one vessel), IIb (two or more vessels)
Type II Endoleak Severity
Generally considered lower risk. Often managed conservatively with monitoring. Intervention required if persistent (>6 months) or if aneurysm sac enlarges >5mm.
Type II Endoleak Management
Conservative ‘wait and see’ approach for stable aneurysms. If intervention needed, options include transarterial or translumbar embolization.
Type IIa Endoleak
Retrograde flow from only one collateral artery.
Type IIb Endoleak
Retrograde flow from two or more collateral arteries.
Type III Endoleak
Structural stent-graft failure or disconnection between modular components. Subtypes: IIIa (junctional separation), IIIb (fabric disruption)
Type III Endoleak Severity
High risk, similar to Type I. Requires prompt intervention due to direct communication with systemic pressure. High risk of aneurysm rupture.
Type III Endoleak Management
Usually managed with additional stent-graft placement. May require conversion to open repair if endovascular approach fails.
Type IIIa Endoleak
Junctional separation of modular components of the device.
Type IIIb Endoleak
Stent-graft fabric disruption.
Type IV Endoleak
Caused by porosity of the endograft fabric. Usually seen immediately after placement and resolves within 30 days.
Type IV Endoleak Severity
Low risk. Generally resolves spontaneously within 30 days post-procedure. Rarely requires intervention.
Type IV Endoleak Management
Typically managed with observation. No specific treatment recommended unless persistent beyond 30 days.
Type V Endoleak (Endotension)
Expansion of the aneurysm sac without signs of other types of contrast extravasation. Diagnosis of exclusion.
Type V Endoleak (Endotension) Severity
Variable risk. Severity depends on rate of aneurysm sac growth. Requires close monitoring.
Type V Endoleak Management
Management is controversial. Options range from continued surveillance to endovascular re-intervention or open surgical repair, depending on sac growth rate and patient factors.
