Presentation
A 80 year old male patient presented with shock and abdominal pain at our emergency medical department. He had a history of abdominal aortic aneurysm treated with an endoprosthesis (EVAR) 10 years ago. At the last follow-up image control (4 months ago), a type Ic endoleak has been reported. The patient was awaiting for treatment in our hospital.
Patient Data
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Type Ic endoleak arising from the right iliac limb of the aortic stent-graft associated to an extravasation of contrast medium arising from the right side wall of the aneurismal sac. Note the presence of perianeurysmal hematoma. A large left sided retroperitoneal hematoma appears to arise from this segment of the abdominal aorta.
3D Volume Rendering showing type Ic endoleak.
Endoleaks classification
Endoleak types or classification
Case Discussion
Endoleak: Persistent perfusion of excluded aneurysm sac after endograft placement.
- Type I: perfusion of aneurysm sac via incomplete/ineffective seal at endograft attachment site.
- Type IA: originates at proximal attachment site
- e.g. infrarenal attachment of upper margin of bifurcated abdominal aortic endograft body
- e.g. infrarenal attachment of upper margin of bifurcated abdominal aortic endograft body
- Type IB: originates at distal attachment site
- e.g. common iliac artery attachment of limb of bifurcated abdominal aortic endograft
- Type IA: originates at proximal attachment site
Type I endoleak should always be repaired when identified: If noted during EVAR or thoracic endovascular aortic repair (TEVAR), should be treated at that time. Should also treat any delayed type I endoleak seen on follow up imaging.
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