Summary:
After the innovative application of endovascular treatment for aneurysms of the
abdominal aorta by Parodi, was considerable enthusiasm for the process, because
of low morbidity and mortality and the ability to manage high-risk patients.
During the last two decades, increased internationally the number of patients
treated intravascularly, but appeared exaggerative application of the method
(often outside IFU). The high rate of technical success, eventually
overshadowed by questions about the strength of the method in time
(durability). The most serious drawback of the method is the endoleaks,that
lead to skepticism as to whether patients are actually protected from the
possibility of rupture and potential death. Therefore, the long-term
observation is needed.
Endoleaks are classified into type I, II, III, IV, V. The treatment of
endoleaks I to IV, have been standardized and internationally accepted. The
increase in aneurysm diameter (endotension), especially when accompanied by
symptoms is a challenge for the medical team, especially when it comes to
high-risk patients. The endoleak type V, is characterized by enlargement of the
aneurysm without detectable endoleak.
Effort has been made for further classification of endotension, as it may
conceal any other endoleak, with a special place to be hold by the true
endoleak (sealed endoleak).
Sufficient number of authors propose open conversion as the radical solution,
but questions are born as far as very high-risk patients are concerned.
Alternatively, a new endovascular treatment with a new endograft is proposed or
even just simple monitoring.
In conclusion, it is estimated that each patient should be treated as a
separate entity, with the criteria of aneurysm size and the increase rate of
the diameter, the degree of risk for open conversion, the hemodynamic status of
the patient and the presence of symptoms.
Keywords:
Endoleak, Endotension, AAA enlargement, Diagnosis, Therapy
