Indications

• Type 2 Endoleak: Expanding

  • • Perfusion of the aneurysm sac by arterial branches that allow for reverse flow back into the aortic segment around the endograft

    • Endoleak acts as a nidus, similar to an AVM, and must be eliminated

• Most other types are addressed by Vascular Surgery at UNC

Contraindications

• Absolute: None.

• Relative:

  • • Stable aneurysm sac over time despite imaging showing Type 2 leak

    • Uncorrectable bleeding diathesis

    • Contrast allergy (premedicate, as time allows)

    • Renal impairment

Imaging Review

• CTA Endograft (noncon, arterial, delay)

  • • Endoleak type cannot always be determined

    • Look for feeding vessel. Can it be accessed transarterially or will direct stick of the endoleak sac (transabdominal or translumbar) be necessary

    • Calcifications on noncon should not be confused for leak; can be used to localize leak with CT imaging during procedure

• MRA

  • • Can be very sensitive for presence of endoleak, but metallic and pulsation artifact make it less desirable and not first-line

    • FerraHeme contrast agent can be used as good alternative with renal impairment or iodinated contrast allergies.

Tips for Workup

• Can the pt tolerate supine and/or prone positioning for several hours? If not, then anesthesia may be required.

• Can coagulopathy be reversed?

• Consent: Risk of non-target embolization, sac rupture, contrast nephropathy, access site complications