[Diagnosis and treatment of endoleak after thoracic endovascular aortic repair or endovascular aortic repair].

Endoleak is a common complication after thoracic endovascular aortic repair (TEVAR) or endovascular aortic repair (EVAR), occurring in up to 30% of cases, and therefore lifelong imaging surveillance is important. Endoleak is defined as the persistence of blood flow outside the lumen of the stent graft, but within the aneurysm, which can be classified into five categories. Typical features of the different types of endoleak are discussed as well as the imaging modalities to detect and classify an endoleak and the endovascular treatment options. Multidetector computed tomography angiography is the most widely used technique for the detection of endoleaks after TEVAR and EVAR. Type I and III endoleaks require immediate treatment because they are prone to rupture. Treatment is restricted to type II endoleaks with enlargement of the aneurysm sac > 5mm over a 6-month period or > 10mm in comparison with the diameter before treatment. The concept of the intervention should be to embolize the inflow and outflow vessels and the communicating channels in between, mainly using glue. Treatment of type V endoleaks (endotension) remains unclear and may be conservative, endovascular (placing a new stent graft), or surgical.