Endoleak therapy (Zertifzierung: Modul A Spezialkurs)

Endoleaks (ELs) are common (10 – 50%) after Endovascular Aortic Aneurysm Repair (EVAR). Type I ELs are caused by failure of sealing at the attachment sites of the endograft, either proximally (EL Ia), or distally (EL Ib). Type II ELs are caused by retrograde flow into the aneurysm sac from aortic or iliac branches. ELs type II occur in 20 – 30% of EVAR cases at 30 days. Mostly they disappear spontaneously. Type III ELs are caused by modular disconnection or fabric disruption. Type IV ELs are attributed to the porosity of the endograft fabric, and they resolve spontaneously. Type V ELs (endotension) are defined as sac enxpansion without evident EL.

Type I ELs are at high risk for continued aneurysm expansion and rupture; they should be treated immediately. Sealing is achieved with expansion of the endograft with large balloons or large diameter bare stents. If anatomically possible a proximal cuff or distal extender are used. If these fail, conversion to open repair is mandatory.

Likewise type III ELs present high risk for rupture; they should be treated immediately with additional stent grafts or by entirely relining of the endograft with a new one.

Type II ELs are treated whenever associated with sac expansion: EL embolization can be done by catheterization of the lumbar arteries, or the IMA, or by direct CT/ultrasound guided sac puncture. Although type IV ELs do not represent a common problem, Type V ELs associated with continued sac enlargement require surgical conversion.

Lernziele:

ELs are commonly associated with EVAR. Prompt diagnosis and classification are required. Most of them can be treated with interventional methods.

E-Mail: [e-mail]