Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Luong D, Glick Y, et al. Type II endoleak. Reference article, Radiopaedia.org (Accessed on 18 Apr 2024) https://doi.org/10.53347/rID-54657
A type II endoleak refers to an endoleak due to flow through open collateral arteries after an endovascular abdominal aortic repair (EVAR).
They are the most common type of endoleak and may occur in 10-44% of patients having repairs and can comprise around half of all endoleaks 1.
They may be simple or complex. Simple leak usually occurs secondary to backflow (retrograde) from collateral arteries, most notably from the inferior mesenteric and lumbar vasculature. They may also occur from other aortic collaterals such as the internal iliac, median sacral or accessory renal arteries.
CT
CT has the ability to acquire sequential images at a number of different “phases”:
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non-contrast phase: acquired first to detect high attenuating structures such as calcium or mural thrombus
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arterial and delayed phases: used to visualize arterial structures and “late” events such as endoleaks, which are not necessarily visible during the arterial phase
The aneurysm may expand on sequential studies due to blood actively flowing into it.
Dual-energy CT
Dual-energy CT acquires datasets at two different photon spectra in a single acquisition and provides both enhanced and nonenhanced data. It can be used to detect endoleaks with good accuracy and at a reduced radiation exposure.
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aortic aneurysm rupture: a rupture after EVAR secondary to an isolated type II endoleak is rare (less than 1 %, but over a third are thought to occur in the absence of sac expansion 3
Treatment and prognosis
It usually resolves spontaneously over time and requires no treatment. Some recommend intervention in patients with type II endoleak when the sac diameter is 10 mm or more 9. Embolization of the branch vessel is indicated if the aneurysm sac continues to expand in size. Such options include
- transarterial embolotherapy
- translumbar and direct sac embolotherapy
- percutaneous transcaval embolization
- laparotomy with arterial ligation, especially for multiple endoleak channels 10
Endoleaks with a stable or decreased aneurysmal sac size may be followed up with CT, given the generally high rates of spontaneous resolution and a low risk of rupture in published literature 5.
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1. Brown A, Saggu GK, Bown MJ, Sayers RD, Sidloff DA. Type II endoleaks: challenges and solutions. Vascular health and risk management. 12: 53-63. doi:10.2147/VHRM.S81275 - Pubmed
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2. Steinmetz E, Rubin BG, Sanchez LA, Choi ET, Geraghty PJ, Baty J, Thompson RW, Flye MW, Hovsepian DM, Picus D, Sicard GA. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. Journal of vascular surgery. 39 (2): 306-13. doi:10.1016/j.jvs.2003.10.026 - Pubmed
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3. Sidloff DA, Stather PW, Choke E, Bown MJ, Sayers RD. Type II endoleak after endovascular aneurysm repair. The British journal of surgery. 100 (10): 1262-70. doi:10.1002/bjs.9181 - Pubmed
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4. Avgerinos ED, Chaer RA, Makaroun MS. Type II endoleaks. Journal of vascular surgery. 60 (5): 1386-91. doi:10.1016/j.jvs.2014.07.100 - Pubmed
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5. Tolia AJ, Landis R, Lamparello P, Rosen R, Macari M. Type II endoleaks after endovascular repair of abdominal aortic aneurysms: natural history. Radiology. 235 (2): 683-6. doi:10.1148/radiol.2352040649 - Pubmed
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6. Güntner O, Zeman F, Wohlgemuth WA, Heiss P, Jung EM, Wiggermann P, Pfister K, Stroszczynski C, Müller-Wille R. Inferior mesenteric arterial type II endoleaks after endovascular repair of abdominal aortic aneurysm: are they predictable?. Radiology. 270 (3): 910-9. doi:10.1148/radiol.13130489 - Pubmed
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7. Bryce Y, Schiro B, Cooper K, Ganguli S, Khayat M, Lam CK, Oklu R, Vatakencherry G, Gandhi RT. Type II endoleaks: diagnosis and treatment algorithm. (2018) Cardiovascular diagnosis and therapy. 8 (Suppl 1): S131-S137. doi:10.21037/cdt.2017.08.06 - Pubmed
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8. Jouhannet C et.al. Reinterventions for Type 2 Endoleaks With Enlargement of the Aneurismal Sac After Endovascular Treatment of Abdominal Aortic Aneurysms. (2014) Annals of vascular surgery. doi:10.1016/j.avsg.2012.10.038 - Pubmed
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9. Moll F, Powell J, Fraedrich G et al. Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg. 2011;41:S1-S58. doi:10.1016/j.ejvs.2010.09.011 - Pubmed
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10. Hinchliffe R, Singh-Ranger R, Whitaker S, Hopkinson B. Type II Endoleak: Transperitoneal Sacotomy and Ligation of Side Branch Endoleaks Responsible for Aneurysm Sac Expansion. J Endovasc Ther. 2002;9(4):539-42. doi:10.1177/152660280200900425 - Pubmed
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