Endoleak - types of endoleaks after endovascular aneurysm repair (EVAR)

The term "endoleak" was proposed in 1996 by White et al. in a letter to editor, where the authors described its basic types. It refers to a failure of endovascular aneurysm repair (EVAR) with persistent blood flow within an aneurysm sac but outside the lumen of the endoluminal graft. Persistent endoleak causes continued pressurization of the aneurysm with the risk of its rupture as a consequence.

Type Subtype Description
Type I   insufficient seal at the site of graft attachment - at proximal or distal end, or at overlap of components
  Ia around the proximal end of the body of stentgraft
  Ib around the distal end of the body of stentgraft
  Ic around the distal end of the iliac component
Type II   perfusion of the aneurysm sac via branch or collateral vessels
  IIa single vessel
  IIb ≥2 vessels
Type III   endoleak throught a defect in the stentgraft or inadequate sealing of overlapping stentgraft components
  IIIa junctional separation of overlapping stentgraft components
  IIIb defect in the stentgraft - fracture of the stentgraft or rupture of the graft fabric
Type IV   leak through the stentgraft fabric due to its porosity
Type V   endotension - expansion of the aneurysm continues despite no evidence of leak on imaging


1. White GH, Yu W, May J. Endoleak--a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg. 1996 Feb;3(1):124–5.
2. Cao P, De Rango P, Verzini F, Parlani G. Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair. J Cardiovasc Surg (Torino). 2010 Feb;51(1):53–69