Endoleaks during follow-up after endovascular repair of abdominal aortic aneurysm. Are they all dangerous?

AIM: Development of endovascular abdominal aortic aneurysm repair (EVAR) has been accompanied by previously unencoutered complications. The most challenging but least understood of these complications is incomplete seal of the endovascular graft (endoleak), a phenomenon which has a variety of causes. An important consequence of endoleakage may be persistent pressurisation of the aneurysm sac, which may ultimately lead to post-EVAR rupture.

METHODS: Data of 110 European centers were recorded in a central database (EUROSTAR). Patient, anatomic characteristics and operative and device details were correlated with the occurrence of different types of endoleaks. Outcome events during follow-up, notably expansion of the aneurysm, incidence of conversion to open repair and post-EVAR rupture were assessed in the different categories of endoleaks and in a group of patients without any endoleak.

RESULTS: Type I and III endoleak were associated with an increased frequency of open conversions or risk of rupture of the aneurysm. Device-related endoleaks also correlated with an increased need for secondary interventions. These types of endoleak need to be treated without delay, and when no other possibilities are present, an open conversion to avert the risk of rupture should be considered. Endoleaks type II do not pose an indication for urgent treatment. However, they may not be harmless, as there was a frequent association with enlargement of aneurysm and reinterventions.

CONCLUSION: Our findings suggest that more frequent surveillance examinations are indicated than in patients without collateral endoleak. The indication for intervention is primarily dictated by documented expansion of the aneurysm.