Vascular CT Appearances

Endoleak CT Findings

Type 1:

• Proximal or distal stent not in complete contact with aortic wall
• Diameter of aorta too large at stent landing zone
• Gap between stent and aortic wall allows blood to flow into aneurysm sac

Type II:

• Retrograde flow through aortic branch vessels into aneurysm sac
• Intercostal arteries in chest, lumbar arteries and IMA in abdomen
• May be difficult to see on arterial phase images
• Must distinguish from calcification in aneurysm sac

Type III:

• Device failure
• Leakage of contrast through a hole in the graft
• Leakage between segments of a modular graft

Type IV:

• Transient porosity

Type V:

• Refractory occult Endoleak
• No identifiable endoleak on imaging
• Aneurysm continues to expand

Other Information About Endoleak

Etiology:

• Complication of EVAR

Epidemiology:

• Anyone with EVAR is susceptible to an endoleak

Presentation:

• Endoleaks do not cause symptoms by themselves but may cause aneurysm to expand or rupture, which can have the following symptoms:
  • Sudden, severe abdominal pain
  • Tachycardia
  • Shortness of breath
  • Hypotension
  • Loss of consciousness

Prognosis:

• Must be treated to prevent life-threatening complications

Related Pearls: TEVAR