ENDOLEAK AS A COMPLICATION OF ENDOLUMINAL GRAFTING OF ABDOMINAL AORTIC-ANEURYSMS - CLASSIFICATION, INCIDENCE, DIAGNOSIS, AND MANAGEMENT

The inability to obtain or maintain a secure seal between a vessel wal l and a transluminally implanted intra-aneurysmal graft is a complicat ion unique to the evolving technique of endovascular aneurysm exclusio n. Because the term ''leak'' has long been associated with aneurysm ru pture, the term ''endoleak'' is proposed as a more definitive descript ion of this phenomenon. Embracing both persistent blood flow into the aneurysmal sac from within or around the graft (graft related) and fro m patent collateral arteries (nongraft related), endoleak can be class ified as primary or secondary depending on the time of occurrence (wit hin 30 days of implantation or following apparent initial seal, respec tively). Diagnostic techniques to detect endoleak include arteriograph y, intraprocedural pressure monitoring, contrast-enhanced computed tom ography, abdominal X ray, and duplex scanning. Management strategies f or endoleak range from observation with periodic imaging surveillance to correction by additional endoluminal or surgical procedures. Standa rdization of the terminology describing this important sequela to endo vascular aneurysm exclusion should facilitate uniform reporting of cli nical trial data vital to the evaluation of this emerging technique.