Background
Abdominal aortic aneurysms (AAA) are common with a predilection for impacting men over women. Unfortunately, the mortality associated with the complications of an untreated aneurysm is nearly 80%. Treatment of AAA also comes with great risk, however over the last few years, minimally invasive endovascular repair (EVAR) has decreased 30-day mortality compared to open repair of these aneurysms in the elective setting. However, with the introduction of EVAR, there has also been insight into complications related to this technique, primarily: endoleaks, impacting nearly 30% of patients who undergo EVAR. There are four types of endoleaks, of which type II is the most common. Although most of these are self resolving, there is a subset of type II endoleaks that require intervention. The objective of this exhibit is to review the imaging patterns associated with each type of endoleak (I-IV), the interventional radiology approach to treatment, and the complications of treatment with specific case based/pictorials from our institution.
Educational Goals / Teaching Points
Review the etiology and anatomy of vascular aneurysms. Discuss the guidelines for monitoring and management of aneurysms including infrarenal abdominal aortic aneurysms (AAA). Discuss the management options of aneurysms. Review the definition and types of endoleaks through imaging findings. Review the management and treatment options for the various types of endoleaks. Discuss the complications of treating endoleaks.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will focus on discussing the etiology and anatomy of aneurysms, the role of imaging modalities (ultrasound, CT, and Angiography), and the complications of EVAR, primarily endoleaks. This will be followed by a case based pictorial review of the types of endoleaks with key imaging findings on CT and angiography, and specific cases of endovascular intervention for the treatment of endoleaks with examples of cases from our institution and a review of key findings on angiography and follow-up imaging.
Conclusion
In conclusion, through this exhibit, we hope to provide a comprehensive overview of recognizing endoleaks in a patient who underwent EVAR through identifying key imaging features and discussing the options for treatment using case-based examples and images.
