Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference.
OBJECTIVE
Endoleaks and endotension are critically important complications of some endovascular aortic aneurysm repairs (EVARs). For the resolution of controversial issues and the determination of areas of uncertainty relating to these complications, a conference of 27 interested leaders was held on November 20, 2000.


METHODS
These 27 participants (21 vascular surgeons, five interventional radiologists, one cardiologist) had previously answered 40 key questions on endoleaks and endotension. At the conference, these 40 questions and participant answers were discussed and in some cases modified to determine points of agreement (consensus), near consensus (prevailing opinion), or disagreement.


RESULTS
Conference discussion added two modified questions for a total of 42 key questions for the participants. Interestingly, consensus was reached on the answers to 24 of 42 or 57% of the questions, and near consensus was reached on 14 of 42 or 33% of the questions. Only with the answers to four of 42 or 10% of the questions was there persistent controversy or disagreement.


CONCLUSIONS
The current endoleak classification system with some important modifications is adequate. Types I and II endoleak occur after 0 to 10% and 10% to 25% of EVARs, respectively. Many (30% to 100%) type II endoleaks will seal and have no detrimental effect, which never or rarely occurs with type I endoleaks. Not all endoleaks can be visualized with any technique, and increased pressure (endotension) can be transmitted through clot. Aneurysm pulsatility after EVAR correlates poorly with endoleaks and endotension. An enlarging aneurysm after EVAR mandates surgical or interventional treatment. These and other conclusions will help to resolve controversy and aid in the management of these vexing complications and should also point the way to future research in this field.
Veith
Frank J
FJ
Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th Street, New York, NY 10467, USA.
Baum
Richard A
RA
Ohki
Takao
T
Amor
Max
M
Adiseshiah
Mohan
M
Blankensteijn
Jan D
JD
Buth
Jacob
J
Chuter
Timothy A M
TA
Fairman
Ronald M
RM
Gilling-Smith
Geoffrey
G
Harris
Peter L
PL
Hodgson
Kim J
KJ
Hopkinson
Brian R
BR
Ivancev
Krassi
K
Katzen
Barry T
BT
Lawrence-Brown
Michael
M
Meier
George H
GH
Malina
Martin
M
Makaroun
Michel S
MS
Parodi
Juan C
JC
Richter
Götz M
GM
Rubin
Geoffrey D
GD
Stelter
Wolf J
WJ
White
Geoffrey H
GH
White
Rodney A
RA
Wisselink
Willem
W
Zarins
Christopher K
CK
D001014:Aortic Aneurysm / Q000601:surgery*; D001291:Attitude of Health Personnel; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003226:Congresses as Topic; D006801:Humans; D011183:Postoperative Complications; D011475:Prosthesis Failure