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Type II Endoleak After EVAR — EECC MCQ

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ModerateAortic DiseaseType II Endoleak After EVAREECC

A 65-year-old man with an abdominal aortic aneurysm undergoes EVAR. At 12-month CT surveillance, a type II endoleak is detected — contrast is seen within the aneurysm sac originating from a lumbar artery. The sac diameter is stable. What is the management?

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Correct answer: C — Observation with serial CT surveillance — type II endoleaks from branch vessels are common (10-25%), often seal spontaneously, and only require intervention if the aneurysm sac is expanding (>5 mm growth)

Endoleaks are classified by the source of persistent blood flow into the aneurysm sac after EVAR: Type I — attachment site leak (proximal/distal seal zone — requires urgent repair); Type II — branch vessel backflow (lumbar, IMA — most common, usually benign); Type III — fabric tear or component disconnection (requires repair); Type IV — graft porosity (rare, self-limiting); Type V — endotension (sac expansion without visible leak). Type II endoleaks occur in 10-25% of EVAR patients. Management per ESC 2024 Aortic Disease Guidelines: (1) observe if sac is stable or shrinking (majority spontaneously seal); (2) intervene (embolisation of feeding branch vessels) only if sac is expanding (>5 mm growth on serial imaging). Long-term CT surveillance after EVAR is mandatory (annual initially, then less frequently if stable).

Reference: ESC (2024): Peripheral Arterial and Aortic Disease Guidelines