A Pictorial Review of Current Approaches in Endoleak Imaging

Figures

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  Figure 1.. Type Ia endoleak. a-c: CT demonstrated a type Ia endoleak, with contrast leaking from the proximal attachment site of the stent-graft into the aneurysm sac, leading to aneurysm rupture (arrow: type Ia endoleak). d, e: Additional aortic extension resolved a type Ia endoleak.

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  Figure 2.. Type Ib endoleak. a-c: Dilation of the left common iliac artery with contrast within and surrounding the stent-graft’s limb, indicative of a type Ib endoleak (arrow: type Ib endoleak). d-f: To address the type Ib endoleak following EVAR, an iliac limb extension was deployed into the external iliac artery. This intervention successfully eliminated the endoleak. Post-procedural CT confirmed the absence of any residual endoleak.

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  Figure 3.. Type II endoleak. a, b: CT revealed contrast enhancement at the periphery of the aneurysm sac, distant from the stent graft, which was suggestive of a type II endoleak (arrow: type II endoleak). c, d: Right iliolumbar artery angiogram demonstrating a type II endoleak via the right 4th lumbar artery. The aneurysm sac has been embolized with NBCA, and the right 4th lumbar artery has been occluded with coils. e, f: Type II endoleak was visualized via a retrograde flow of IMA, which was embolized with coils. g, h: Follow-up axial CT scan 1 year after embolization. The image demonstrates a noticeable reduction in the size of the aneurysmal sac.

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  Figure 4.. Type IIIa endoleak. a, b: CT reveals a type IIIa endoleak at the junction of stent graft components, where separation has occurred (arrow: type III endoleak). c: No endoleak was identified after additional stent-graft placement to provide a new sealing zone. d, e: CT 1 year after stent-graft relining showed shrinkage of the aneurysmal sac.

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  Figure 5.. Type IIIb endoleak. a, b: A linear area of contrast enhancement was visualized near the flow divider of stent-graft, which was suspected of type IIIb endoleak (arrow: type IIIb endoleak). c: Angiography within the stent graft identified a type IIIb endoleak through the graft fabric near the flow divider (arrow: type III endoleak). Stent graft relining successfully eliminated the endoleak. d, e: Resolution of endoleak was confirmed in post-procedural CT.

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  Figure 6.. Type IV endoleak. a, b: Completion angiography showed contrast with a diffuse haziness surrounding the stent-graft, indicative of a type IV endoleak. c, d: While the endoleak persisted 1 week after the procedure, it spontaneously resolved within 1 month.

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  Figure 7.. Type V endoleak (endotension). a, b, c: Although EVAR appeared successful (a, b), the 1-year follow-up revealed unexpected sac enlargement with no signs of endoleak (c). d: No obvious endoleak was identified during direct visualization of the stent graft and aneurysmal sac. Following a thorough examination, aneurysm sac plication was performed to address the persistent sac enlargement. e: Sac shrinkage was achieved after aneurysmorrhaphy.