Table 14

Classification of Endoleaks

TypeCause of Perigraft FlowSequelae and Treatment Strategy
IInadequate seal at proximal and/or distal graft attachment siteSystemic arterial pressure transmitted to the aneurysm sac, leading to expansion and rupture. Should be repaired when diagnosed.
IIRetrograde aortic branch arterial blood flow into aneurysm sacMay spontaneously thrombose. If aneurysm is stable or shrinking, observe. If aneurysm is expanding, embolic occlusion of branch artery indicated but often difficult.
IIIStructural failure of endograft (e.g., stent graft fractures, holes in fabric, junctional separations)Systemic arterial pressure transmitted to the aneurysm sac, leading to expansion and rupture. Should be repaired when diagnosed.
IVStent graft fabric porosityNoted at time of implantation and usually resolved with reversal of anticoagulation.
VExpansion of aneurysm without demonstrable endoleak, also called “endotension”Reline the endograft with a second endograft.

Adapted from Veith et al (494).