Algorithm for the management of endoleak after EVAR

EVAR: endovascular aortic repair; IMA: inferior mesenteric artery; CT: computed tomography; MR: magnetic resonance.
* Endograft surveillance using CT or MR angiography or duplex ultrasound is typically at one month, six months, and annually after endograft placement.
¶ Vascular imaging using a different modality for indeterminate endoleak. For type II endoleak, selection is based on modality most likely to demonstrate the source of flow into the aneurysm sac.
Δ For types I or III endoleak, endovascular repair involves reballooning stent-graft fixation sites or deployment of graft extensions. For type II endoleak, successful translumbar or transarterial embolization of vessels feeding the aneurysm sac will resolve the endoleak. For type IV endoleak, relining with a new endograft may be necessary.