Current Views on Type II Endoleaks

As I fly home from London after participating in the Charing Cross Vascular Symposium (35th annual edition!) and begin to review prominent topics presented during the event’s intense 3 days, it becomes clear that post-EVAR type II endoleaks are among the top issues discussed, and a controversial issue at that! An entire session was dedicated to this very topic. 

Although there is not much “new” to report, I did come out with the distinct impression that management guidelines and outcome implications of type II endoleaks may not be as clear as I thought they had become in recent years. Several noted experts in the EVAR field expressed reasoned doubt about the prevailing view that “type II endoleaks are benign,” advancing the concept that such endoleaks may well carry significant long-term potential for AAA complications and the need for reinterventions.  Attention went also to the detection of these endoleaks and how in some cases their true nature can be masked or confused when there is a concomitant type I or III endoleak.

In the end I believe we can safely adhere to the prevailing current view that most type II endoleaks behave in a benign manner and need not be considered for intervention and closure unless they are accompanied by a minimum 5 mm annual sac growth.  However, we must strive to ascertain their true nature in every case, and exclude the more dangerous high-pressure types I and III. We can also look forward to interesting new developments in the foreseeable future, mainly the anticipated availability of the Endologix Nellix “aneurysm sealing system” that promises to nearly eliminate type II endoleaks as the aneurysm sac is completely sealed with two polymer-filled ultrathin polyester endobags. Stay tuned.