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Abdominal Vascular Graft Complications

Unfortunately the presentation for an endoleak is usually completely asymptomatic. However, remember that any patient undergoing endovascular repair can have as high as a 25% postoperative complication rate. Therefore even these non-specific presentations (abdominal pain, hematuria, flank pain, syncope, etc) should trigger you to search for a graft complication.

Thankfully most patients with endografts undergo routine imaging at 30 days, 6 months, and then annually after placement of the graft. The type of imaging varies between institutions but is almost always going to be a CT scan with IV contrast. But now that they are in your ED how do you go about diagnosing them? This is not…

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Articles of Interest

Aortic endoleaks

Endovascular aneurysm repair (EVAR) is complicated by endoleaks in 20 to 25% of patients. This is a potentially serious complication which may lead to abdominal aortic rupture. There are five different types of endoleaks, which are classified based on the source of vessels that causes the inflow into the aneurysm sac.

Identifying and Managing Type III Endoleak After EVAR

Tips for optimal imaging protocols and endovascular treatment techniques to detect and repair type IIIa and IIIb endoleaks.

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

Endovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms, encompassing 80% of all repairs in the United States. Endoleaks are ubiquitous and affect 30% of patients treated by EVAR, potentially leading to sac enlargement and increased risk of rupture.

Techniques and future perspectives for the prevention and treatment of endoleaks after endovascular repair of abdominal aortic aneurysms

The most common reason for re-intervention is the increase of the aneurysmal sac due persistence of flow, a phenomenon otherwise known as “endoleak”.

The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management

There are several complications associated with EVAR. These can be grouped into endograft-associated complications and systemic complications...

The emergency medicine approach to abdominal vascular graft complications

An endoleak is vascular flow outside of the endograft, but still contained in the aortic aneurysm sac. There are 5 different types of endoleaks... Types 1 to 3 are the most common types... This can be difficult, as many endoleak presentations are asymptomatic or nonspecific, unless the AAA has ruptured. Fortunately, most patients with endografts undergo routine imaging at 30 days, 6 months, and annually after placement of the graft. The type of imaging varies between institutions but is most commonly CT with intravenous contrast.

Type II endoleaks: challenges and solutions

Type II endoleaks are the most common endovascular complications of endovascular abdominal aortic aneurysm repair (EVAR); however, there has been a divided opinion regarding their significance in EVAR.

Resources

Endoleaks (Type I-V)

Usually an endoleak causes no symptoms at all. Often, an endoleak is found during a routine follow-up visit with your vascular surgeon after you have had an EVAR procedure.

Radiopaedia

Endoleaks are characterized by persistent blood flow within the aneurysm sac following endovascular aneurysm repair (EVAR). Normally the aortic stent-graft used for EVAR excludes the aneurysm from the circulation by providing a conduit for blood to bypass the sac.