Management of endoleaks after EVAR (2024 – CME)
Description
Authors: P. Desgranges, H. Kobeiter, and V. Tacher
Reviewers: M. Das, R. Patel, T. Rand, F. Wolf and R. Uberoi
This course corresponds to chapter 2.2.1.1.3 Acute aortic syndromes and aneurysmal disease in the European Curriculum and Syllabus for IR.
Abstract
Minimal invasive vascular repair of abdominal aortic aneurysm was first reported in 1986. In the early 1990s endovascular aneurysm repair (EVAR) was developed for the treat
Endovascular aneurysm repair (EVAR) is the current standard of care for abdominal aortic aneurysms, representing the majority of all procedures used for the treatment of abdominal aortic aneurysm for patients unfit for open repair. Short-term survival benefits of EVAR versus open repair in the treatment of abdominal aortic aneurysm have been widely accepted. Long-term studies found that aneurysm-related deaths increased from six months after EVAR. The predominate cause of death was aneurysm rupture, which was partly due to sac expansion resulting from uncorrected endoleak. Endoleak is a concern after EVAR, with a reported incidence of 20-50% of patients, although the majority (type II endoleaks) may be benign and treated conservatively. Endoleaks are classified into five types, and treatment is variable according to the endoleak type and the advent of aneurysm sac enlargement. Endovascular or percutaneous treatment are the most frequent therapeutic options in endoleaks management to prevent sac rupture.
Approximately half of endoleaks are type II, which are treated only in case of sac enlargement, whereas type I and III endoleaks usually require early intervention.
This course will provide an overview of the management of endoleaks after EVAR, including endoleak diagnosis, physiology, indications and contraindications of treatment, techniques for treatment (learning video), post-procedural management, follow-up, and outcomes.
Learning objectives
- To define endoleak classification and recognize the imaging features of endoleaks
- To understand the indications for treatment of endoleaks
- To describe interventional radiology techniques and planning required for differing endoleak types
- To understand the utility of balloon remodeling, deployment of large bare stents or extension cuffs, FEVAR or BEVAR placement, occasionally transcatheter embolization and endoanchors placement of the endoleak lumen to achieve seal in type I endoleaks
- To understand the utility of transcatheter embolization of feeding and draining branch vessels or percutaneous trans-sac injection of embolic materials to treat type II endoleaks
- To learn about the insertion of graft extensions, cuffs, and relining with new bifurcated stent-grafts to treat type III endoleaks
- To learn how to recognize and manage type IV and V endoleaks
- To understand the post-procedural follow-up requirements in patients with treated endoleaks
Further information
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapter 2.2.1.1.3 Acute aortic syndromes and aneurysmal disease.
The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC). The CME accreditation for this course will expire on September 24, 2026. A non-CME accredited version of the course will remain available for two more years.
The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.
The enrolment period of this course is linked to the validity of the All-Access Pass.
Release date: September 2024
