Endovascular management of "endoleaks" after transluminal infrarenal abdominal aneurysm repair

Purpose: To investigate the reasons for endoleaks after transluminal infrarenal abdominal aneurysm management and the potential for transluminal interventions in subsequent management. Methods: Prospective analysis of 50 consecutive patients undergoing endovascular aneurysm repair at a single institution with Stentor(R) and Vanguard(R) grafts from March 1995 to March 1997. Setting: Academic teaching hospital. Results: Two procedures were converted for other reasons than leak. In the remaining 48 successful procedures endoleaks were detected in 11 (22.9%): proximal aortic leak (2.1%), distal aortic leak (8.3%), iliac leak (12.5%). Leaks were treated at the initial procedure in five patients, resulting in 87.5% excluded aneurysms. Twelve and a half per cent were discharged with a primary leak. Redo was performed on all iliac leaks within 7 weeks. All aortic leaks showed spontaneous thrombosis within 3 months, but reappeared with local aneurysm expansion. Aortic redo-procedures were performed by proximal tubular extension or converting a tube graft into a bifurcation graft. All rescue procedures were successful. Secondary leaks have been observed twice in this series, both treated by endovascular means. Conclusions: Endovascular treatment of primary and secondary endoleaks is possible, and may be a safe alternative to a difficult open procedure.