The problem of endoleak in endoluminal therapy

Endovascular treatment of aortic aneurysms with stent grafts was performed increasingly in recent years. The most frequent complication after endovasc ular therapy of aortic aneurysms is an endoleak. In case of a persistent en doleak, diameter of the aneurysm is increasing with a high risk of aneurysm ruptur. Diagnostic tools are spiral computed tomography and angiography. Spiral com puted tomography is the most sensitive method for the diagnosis of an endol eak ad should be performed with a biphasic acquisition. In- and outflow of sidebranches can be identified correctly with selective angiography in 86%. Perigraft endoleaks should be treated in any case. Patent side branches ge nerally are observed over a period of 6 months. After 6 months approximatel y half of these endoleaks are thrombosed. Is there an increasing of the dia meter of the aneurysm or any changing in the morphology of the aneurysm the re is an indication for embolisation of these sidebranches of the aneurysma l sac. Preinterventional embolisation of patent sidebranches is under discu ssion. Type I endoleaks can be managed by additional stent-graft implantation or c oil embolisation. In case of type 11 endoleaks in- ad outflow vessles shoul d be embolised with coils. Therapy of type III endoleak is performed mostly by additional stent-graft placement. The total incidence of secondary inte rventions in the Eurostar-study was nearly 10% per year.