Type I endoleak
Updates to Article Attributes
Type I endoleaks are sub group of endoleaks which occur at graft ends (inadequateoften due to inadequate seal). T
Pathology
They occur as a result of poor apposition between one of the attachment sites of a stent-graft and the native aortic or iliac artery wall. A blood can leak can occur through this defect into the aneurysm sac.
Type I endoleaksTjey can be seen immediately after stent-graft deployment due to several reasons including
- incomplete dilation of the stent-graft, aortic tortuosity
- steep aortic angulation.
Delayed type I endoleaks may be related to changes in the configuration of the aorta as the aneurysm sac shrinks. These are considered high-pressure endoleaks, and there is a high risk of aneurysm sac rupture because of direct exposure of the aneurysm wall to aortic pressure.
Associations
- can be most common after repair of thoracic aortic aneurysms 4
Sub types
They can be subgrouped in to three further types
- Ia: proximal
- Ib: distal
- Ic: iliac occluder
Radiographic features
Type I endoleaks are can be associated with measurable increases in aneurysm sac size.
CT angiography
Usually preferred imaging modaility of choice. Multiphased scanning is helpful. Unenhanced CT may show hyperattenuating acute haemorrhage within the aneurysm sac.
After contrast administration, a dense contrast collection is usually seen centrally within the sac and is often continuous with one of the attachment sites.
Ultrasound
On Doppler sonography, a jet of flow may be seen originating from one of the attachment sites.
Treatment and prognosis
Type Ia leaks
Initial treatment can include balloon angioplasty of the proximal attachment site, aimed at remodeling the stent graft to achieve adequate seal. If angioplasty is unsuccessful, balloon expandable bare metal stents such as Palmaz stents can be deployed over the affected attachment site to promote apposition of the proximal stent graft with the aortic wall.
In cases of undersized or maldeployed endografts, covered extension cuffs, which can usually be matched in size and material to the native endograft.
Some newer devices include EndoStaples and EndoAnchors which mechanically attach the proximal endograft with the aortic wall.
Type Ib leaks
Are usually considered easier to manage than IA, with numerous available iliac extender limbs, covered stents, and bare metal stents to close the endoleak defect.
Despite these advances in endovascular techniques, there are still cases that require surgical repair for definitive treatment.
-<p><strong>Type I endoleaks</strong> are sub group of <a title="Endoleaks" href="/articles/endoleak">endoleaks</a> which occur at graft ends (inadequate seal). T</p><h4>Pathology</h4><p>They occur as a result of poor apposition between one of the attachment sites of a stent-graft and the native aortic or iliac artery wall. A blood can leak can occur through this defect into the aneurysm sac.</p><p>Type I endoleaks can be seen immediately after stent-graft deployment due to several reasons including</p><ul>- +<p><strong>Type I endoleaks</strong> are sub group of <a href="/articles/endoleak">endoleaks</a> which occur at graft ends often due to inadequate seal. </p><h4>Pathology</h4><p>They occur as a result of poor apposition between one of the attachment sites of a stent-graft and the native aortic or iliac artery wall. A blood can leak can occur through this defect into the aneurysm sac.</p><p>Tjey can be seen immediately after stent-graft deployment due to several reasons including</p><ul>
-</ul><h4>Radiographic features</h4><p>Type I endoleaks are can be associated with measurable increases in aneurysm sac size.</p><h5>CT angiography</h5><p>Usually preferred imaging modaility of choice. Multiphased scanning is helpful. Unenhanced CT may show hyperattenuating acute haemorrhage within the aneurysm sac.</p><p>After contrast administration, a dense contrast collection is usually seen centrally within the sac and is often continuous with one of the attachment sites.</p><h5>Ultrasound</h5><p>On Doppler sonography, a jet of flow may be seen originating from one of the attachment sites.</p>- +</ul><h4>Radiographic features</h4><p>Type I endoleaks are can be associated with measurable increases in aneurysm sac size.</p><h5>CT angiography</h5><p>Usually preferred imaging modaility of choice. Multiphased scanning is helpful. Unenhanced CT may show hyperattenuating acute haemorrhage within the aneurysm sac.</p><p>After contrast administration, a dense contrast collection is usually seen centrally within the sac and is often continuous with one of the attachment sites.</p><h5>Ultrasound</h5><p>On Doppler sonography, a jet of flow may be seen originating from one of the attachment sites.</p><h4>Treatment and prognosis</h4><h6>Type Ia leaks</h6><p>Initial treatment can include balloon angioplasty of the proximal attachment site, aimed at remodeling the stent graft to achieve adequate seal. If angioplasty is unsuccessful, balloon expandable bare metal stents such as Palmaz stents can be deployed over the affected attachment site to promote apposition of the proximal stent graft with the aortic wall.</p><p>In cases of undersized or maldeployed endografts, covered extension cuffs, which can usually be matched in size and material to the native endograft.</p><p>Some newer devices include EndoStaples and EndoAnchors which mechanically attach the proximal endograft with the aortic wall.</p><h6>Type Ib leaks</h6><p>Are usually considered easier to manage than IA, with numerous available iliac extender limbs, covered stents, and bare metal stents to close the endoleak defect.</p><p>Despite these advances in endovascular techniques, there are still cases that require surgical repair for definitive treatment.</p><p> </p>
References changed:
- 1. Kudo T, Kuratani T, Shimamura K, Sakamoto T, Kin K, Masada K, Shijo T, Torikai K, Maeda K, Sawa Y. Type 1a endoleak following Zone 1 and Zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration. (2017) European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 52 (4): 718-724. <a href="https://doi.org/10.1093/ejcts/ezx254">doi:10.1093/ejcts/ezx254</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29156021">Pubmed</a> <span class="ref_v4"></span>
- 2. Shen A, Ologun GO, Keller H, Sampson L. Natural History Of an Untreated Type 1 Endoleak: A Case Report. (2017) Cureus. 9 (7): e1507. <a href="https://doi.org/10.7759/cureus.1507">doi:10.7759/cureus.1507</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28948127">Pubmed</a> <span class="ref_v4"></span>
- 3. Mustafa R. Bashir, Hector Ferral, Chad Jacobs, Walter McCarthy, Marshall Goldin. Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair: Management Strategies According to CT Findings. (2012) American Journal of Roentgenology. 192 (4): W178-86. <a href="https://doi.org/10.2214/AJR.08.1593">doi:10.2214/AJR.08.1593</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19304678">Pubmed</a> <span class="ref_v4"></span>
- 4. Chen J & Stavropoulos S. Management of Endoleaks. Semin Intervent Radiol. 2015;32(3):259-64. <a href="https://doi.org/10.1055/s-0035-1556825">doi:10.1055/s-0035-1556825</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26327744">Pubmed</a>
- 5. Jonathan L. Eliason, Gilbert R. Upchurch. Endovascular Abdominal Aortic Aneurysm Repair. (2008) Circulation. 117 (13): 1738. <a href="https://doi.org/10.1161/CIRCULATIONAHA.107.747923">doi:10.1161/CIRCULATIONAHA.107.747923</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18378627">Pubmed</a> <span class="ref_v4"></span>
Systems changed:
- Vascular
Image 1 Diagram (Endoleaks schematic classification) ( create )
Image 3 CT (C+ delayed) ( create )
Image 4 CT (C+ arterial phase) ( create )
Image 5 CT (C+ arterial phase) ( create )
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