Evolving Concepts, Management, and Treatment of Type 1 Endoleaks after Endovascular Aneurysm Repair

Abstract

Over the past 20 years, there has been tremendous progress in endovascular aneurysm repair techniques and devices. The application of new third- and fourth-generation devices (from 2003 onward) has led to changes in the incidence and management of endoleaks. This comprehensive review aims to outline the most recent concepts with respect to pathophysiology/risk factors and management of Type 1 endoleaks.

Keywords: EndoAnchors; Palmaz stent; aortic neck; endoleak; endovascular aneurysm repair; iliac artery; interventional radiology.

Fig. 1

( a ) The aortic neck angulation is formed between points connecting the lowest renal artery and the origin of the aneurysm. The neck angle (α) should be < 60 degrees. ( b ) A conical/reversed taper neck is present when there is progressive increase of at least 3 mm from the lowest renal artery (D1) to the most proximal part of the aneurysm sac (D3).

Fig. 2

Deployment of a Palmaz stent (arrow) following infolding of the proximal part of the aortic stent graft, resulting in a T1a endoleak.

Fig. 3

EndoAnchors. ( a ) EndoAnchor dimension of 4.5 mm in length and 3.5 mm in diameter. Current catheter used to directionally place the EndoAnchors in the proximal neck with a deflection tip. ( b ) Type 1a endoleak noted on completion angiography (blue arrow). Four EndoAnchors were placed in the proximal neck resulting in resolution of the T1a endoleak on the final angiography.

Fig. 4

Endovascular aneurysm repair with embolization of the internal iliac system. ( a ) Aortic aneurysm involved the right common iliac system (arrow). Catheter is in the internal iliac artery. ( b ) Contrast is injected into the internal iliac artery origin (arrow). ( c ) Completion angiography with embolization of the internal iliac system and extension of the stent graft into the external iliac artery.

Fig. 5

Iliac branch device. ( a ) One-month postoperative CTA that shows a T1b endoleak (arrow) from the distal landing zone in the left common iliac with corresponding increase in both the aortic and common iliac aneurysms. ( b ) Intraoperative angiography of the iliac branch endoprosthesis with wire access in both the external and internal iliac arteries.