Evar

Question 1

What is an endoleak?

Answer 1

Persistent perigraft blood flow within the aneurysm sac with contrast opacification changing in degree and shape between arterial and delayed phases.

Question 2

Type I Endoleak

Answer 2

Leakage from the attachment sites of the stent-graft and native artery. Subtypes: Ia (proximal), Ib (distal), Ic (iliac occluder)

Question 3

Type I Endoleak Severity

Answer 3

High risk. Requires urgent intervention due to direct communication with systemic pressure. High risk of aneurysm rupture if left untreated.

Question 4

Type Ia Endoleak

Answer 4

Leakage at the proximal attachment site. Often due to short, angulated, or tapered proximal necks.

Question 5

Type Ia Endoleak Management

Answer 5

Usually requires prompt endovascular repair. May need additional stent placement, balloon angioplasty, or in severe cases, open surgical repair.

Question 6

Type Ib Endoleak

Answer 6

Leakage at the distal attachment site. Often due to dilated, irregular, or tortuous iliac arteries.

Question 7

Type Ib Endoleak Management

Answer 7

Often managed with distal extension of the graft or embolization. May require open surgical repair if endovascular approach fails.

Question 8

Type Ic Endoleak

Answer 8

Failure of occlusion of the contralateral common iliac artery in patients with aorto-uniliac endograft and femoral-femoral bypass.

Question 9

Type II Endoleak

Answer 9

Retrograde blood flow via collateral vessels (most commonly inferior mesenteric artery and lumbar arteries). Subtypes: IIa (one vessel), IIb (two or more vessels)

Question 10

Type II Endoleak Severity

Answer 10

Generally considered lower risk. Often managed conservatively with monitoring. Intervention required if persistent (>6 months) or if aneurysm sac enlarges >5mm.

Question 11

Type II Endoleak Management

Answer 11

Conservative ‘wait and see’ approach for stable aneurysms. If intervention needed, options include transarterial or translumbar embolization.

Question 12

Type IIa Endoleak

Answer 12

Retrograde flow from only one collateral artery.

Question 13

Type IIb Endoleak

Answer 13

Retrograde flow from two or more collateral arteries.

Question 14

Type III Endoleak

Answer 14

Structural stent-graft failure or disconnection between modular components. Subtypes: IIIa (junctional separation), IIIb (fabric disruption)

Question 15

Type III Endoleak Severity

Answer 15

High risk, similar to Type I. Requires prompt intervention due to direct communication with systemic pressure. High risk of aneurysm rupture.

Question 16

Type III Endoleak Management

Answer 16

Usually managed with additional stent-graft placement. May require conversion to open repair if endovascular approach fails.

Question 17

Type IIIa Endoleak

Answer 17

Junctional separation of modular components of the device.

Question 18

Type IIIb Endoleak

Answer 18

Stent-graft fabric disruption.

Question 19

Type IV Endoleak

Answer 19

Caused by porosity of the endograft fabric. Usually seen immediately after placement and resolves within 30 days.

Question 20

Type IV Endoleak Severity

Answer 20

Low risk. Generally resolves spontaneously within 30 days post-procedure. Rarely requires intervention.

Question 21

Type IV Endoleak Management

Answer 21

Typically managed with observation. No specific treatment recommended unless persistent beyond 30 days.

Question 22

Type V Endoleak (Endotension)

Answer 22

Expansion of the aneurysm sac without signs of other types of contrast extravasation. Diagnosis of exclusion.

Question 23

Type V Endoleak (Endotension) Severity

Answer 23

Variable risk. Severity depends on rate of aneurysm sac growth. Requires close monitoring.

Question 24

Type V Endoleak Management

Answer 24

Management is controversial. Options range from continued surveillance to endovascular re-intervention or open surgical repair, depending on sac growth rate and patient factors.

Question 25

Suture breaks

Answer 25

Breakage of polyester sutures connecting adjacent rings, leading to their separation. Can be minor (<180° of circumference) or major (>180° of circumference).

Question 26

Metal-ring fractures

Answer 26

Discontinuity of the metallic frame of the stent-graft. Can lead to type I and III endoleaks and stent-graft migration.

Question 27

Suture breaks and metal-ring fractures: Clinical significance

Answer 27

Associated with delayed type I and III endoleaks and stent-graft migration. Major suture breaks and metal-ring fractures often require intervention.

Question 28

Device migration: Definition

Answer 28

Device movement of >10 mm on the centerline or >15 mm on either the anterior or posterior aortic margin.

Question 29

Device migration: Consequences

Answer 29

Can lead to type I endoleak (attachment site), type III endoleak (component separation), and device kinking.

Question 30

Device kinking: Definition

Answer 30

Sharp localized angulation >90° of the stent-graft, typically at the limb.

Question 31

Device kinking: Consequences

Answer 31

Can lead to device migration, type I and III endoleaks, endograft thrombosis and occlusion.

Question 32

Graft thrombosis: CT findings

Answer 32

Non-enhancing concentric or eccentric tissue along the internal wall of the endograft.

Question 33

Infection: CT findings

Answer 33

May show periaortic fat stranding, perigraft fluid collections, abnormal enhancement, air bubbles, and erosion into adjacent structures.

Question 34

Access site complications: Types

Answer 34

Include arterial thrombosis, pseudoaneurysm, dissection, groin hematoma, lymphocele, and infection.