Endoleak

classification after EVAR

Classifies persistent aneurysm-sac perfusion after endovascular aneurysm repair by source.

vigenteVascular surgery consensuscurrent2023CT, US, Angiography

IType I, attachment-site leak IIType II, branch-vessel backflow IIIType III, graft defect or component separation IVType IV, graft porosity VType V, endotension

Aplicar o Endoleak a um achado

Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.

Categorias

Reescritas a partir da fonte e citadas

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Type I, attachment-site leak

Inadequate seal at a graft attachment site lets blood track alongside the graft into the aneurysm sac. Subtype Ia is a proximal attachment-site leak; subtype Ib is a distal attachment-site leak.

CondutaGenerally prompt intervention. Type Ia: balloon molding, a proximal cuff or stent, chimney or fenestrated EVAR, anchors, or embolization. Type Ib: distal graft extension. Open conversion if endovascular repair fails.

RiscoHigh rupture risk from continued sac pressurization and expansion.

verificadoThe Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and ManagementPMC10312356 (Yanamaladoddi et al., Cureus 2023), 'Type I Endoleaks'; corroborated by StatPearls NBK554573 'Abdominal Aortic Repair', Complications.

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Type II, branch-vessel backflow

Retrograde (collateral) backflow into the aneurysm sac from aortic side branches, chiefly the lumbar arteries and the inferior mesenteric artery; the most common type overall.

CondutaOften observed; treated when the sac enlarges (about 5 mm or more over roughly 6 months) by transarterial, translumbar/direct-sac, or transcaval embolization, or surgical feeder ligation as an alternative.

RiscoRelatively benign; many resolve within about 6 months, but roughly 55% show sac enlargement within 3 years if persistent beyond 6 months.

verificadoThe Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and ManagementPMC10312356, 'Type II Endoleaks'; corroborated by StatPearls NBK554573, Complications.

III

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Type III, graft defect or component separation

Mechanical graft failure perfusing the sac. Subtype IIIa is separation or disconnection between graft components (junctional); subtype IIIb is a fabric defect, tear, or hole.

CondutaPrompt intervention: endovascular relining with additional graft component(s) bridging or overlining the defect; open conversion if needed.

RiscoHigh rupture risk, comparable to type I.

verificadoThe Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and ManagementPMC10312356, 'Type III Endoleaks'; corroborated by StatPearls NBK554573, Complications.

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Type IV, graft porosity

Blood seeps through the inherent porosity of the graft fabric, with no discrete defect; usually seen early after implantation.

CondutaUsually transient and self-limiting; observation, rarely requiring intervention with modern devices (treatment generally not recommended).

RiscoLow-flow leak with minimal rupture risk; typically resolves once coagulation normalizes.

verificadoThe Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and ManagementPMC10312356, 'Type IV Endoleaks'; risk and 'treatment not recommended' per Society for Vascular Surgery patient guideline (vascular.org 'Endoleaks (Type I-V)') and SVS clinical practice guidelines (J Vasc Surg endoleak management).

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Type V, endotension

Continued aneurysm-sac enlargement after EVAR with no demonstrable endoleak; a diagnosis of exclusion, also called endotension.

CondutaSurveillance, with intervention (graft relining or open conversion) suggested for ongoing sac expansion even without a visible endoleak.

RiscoLow risk in the short term, but continued sac enlargement confers a long-term aneurysm-rupture risk and usually warrants repair.

verificadoThe Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and ManagementPMC10312356, 'Type V Endoleaks'; risk and management per Society for Vascular Surgery patient guideline (vascular.org 'Endoleaks (Type I-V)') and SVS clinical practice guidelines (J Vasc Surg endoleak management, grade 2C).

Lógica de decisão estruturada

{
  "categories": [
    "I",
    "II",
    "III",
    "IV",
    "V"
  ]
}

Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.