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Tech Vasc Interv Radiol. 2018 Sep;21(3):188-195. doi: 10.1053/j.tvir.2018.06.009. Epub 2018 Jun 14.

Step-by-Step Approach to Management of Type II Endoleaks.

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Memorial Sloan Kettering Cancer Center, Division of Interventional Radiology, New York, NY.
Kaiser Permanente Los Angeles Medical Center, Division of Interventional Radiology, Los Angeles, CA.
Massachusetts General Hospital, Division of Interventional Radiology, Department of Radiology, Harvard Medical School, Boston, MA.
Miami Cardiac & Vascular Institute, Miami, FL.
University of Michigan, Division of Interventional Radiology, Ann Arbor, MI.
Mayo Clinic, Division of Interventional Radiology, Scottsdale, AZ.
Miami Cardiac & Vascular Institute, Miami, FL. Electronic address:


Seventy-five percent of abdominal aortic aneurysms are now treated by endovascular aneurysm repair (EVAR) rather than open repair, given the decreased periprocedural mortality, complications, and length of hospital stay for EVAR compared to the surgical counterpart. An endoleak is a potential complication after EVAR, characterized by continued perfusion of the aneurysm sac after stent graft placement. Type II endoleak is the most common endoleak, and often has a benign course with spontaneous resolution, occurring in the first 6 months after repair. However, these type II endoleaks may result in pressurization of the aneurysm sac and potentially sac rupture. They occur from retrograde collateral blood flow into the aneurysm sac, typically from a lumbar artery or the inferior mesenteric artery. Alternative sources include accessory renal, gonadal, median sacral arteries, and the internal iliac artery. We will discuss our protocol for post-EVAR imaging surveillance and potential type II endoleak treatment strategies, including transarterial, translumbar, transcaval, and perigraft approaches, as well as open surgery.


endoleak; endovascular aneurysm repair; translumbar embolization; type II endoleak

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