Biomedical Engineering Reference
In-Depth Information
Table 5
Types of Endoleaks, their description, possible causes, treatment options and overall incidence
Endoleak
Definition
Causes
Treatment options
Average Incidence
Type-I
It includes blood leakage from either
proximal (Ia) or distal (Ib)
attachment sites of stent graft
It is usually result of inappropriate
case selection i.e. patient with
hostile neck or incorrect
deployment [
59
,
79
]
Treatment is mandatory usually
repaired by intervening with
cuffs and extenders [
27
], and
oversizing by 20 % could
minimize risk of late endoleak
For AAA
6
:
5 %
[
59
] and for TAA
20 % [
82
]
Type-II
It is defined as retrograde or back
bleeding of blood through the
branch vessel into aneurismal
sac
It is not a graft related complication,
rather it is from patent vessels
including lumbar and mesenteric
arteries in the sac
It is usually treated by
Embolization. However
process of thrombus formation
can minimize it [
62
]
8
:
0
45 % [
74
]
Type-III
This perigraft leakage resulted from
the dislocation of modular
components and mechanical
failure of stent graft material
Because of insufficient frictional grip
between modular components of
stent-graft, and hostile anatomy
This demands emergency
treatment, usually treated by
using additional limbs, redo
EVAR procedure, and
conversion to open repair as a
last resort
0
:
7
3
:
8% [
74
]
Type-IV
This endoleak commonly seen at the
initial stages of procedure, as a
result of permeation through the
graft material
The reason is porosity of thin walled
fabric graft
Usually, requires no treatment,
seal off itself within first
30 days of EVAR procedure
Initial high
incidence
Type-V or
Endotension
Endotension is pressurization
of aneurysm without any evident
sign of leakage
No well defined reason, however
researchers believe that thrombus
lining and attachment of graft to
aortic wall might be responsible
for transferring pressure wave to
the sac [
27
,
61
]
This demands watchful
surveillance, could be treated
by redo or open conversion
2
5% [
79
]
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