Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents

INTRODUCTION: We report our experience with endovascular treatment (EVT) of circumferential and fusiform intracranial aneurysms by a reconstructive approach with self-expandable stents. METHODS: A retrospective review of our prospectively maintained database identified all circumferential and fusiform aneurysms treated by a reconstructive endovascular approach over a 3-year period. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS: From April 2004 to May 2007, 13 patients were identified, of whom 12 were asymptomatic and 1 presented with a subarachnoid hemorrhage. Two patients with an aneurysm 相似文献   

942例颅内动脉瘤患者血管内治疗围术期出血并发症分析及防治

目的：分析942例颅内动脉瘤患者行血管内治疗的围术期出血并发症发生情况,并探讨其处理措施。 方法：收集2011年1月至2019年4月复旦大学附属华山医院收治的942例颅内动脉瘤患者（1 055个动脉瘤）,分析围术期出血并发症发生原因,探讨围术期用药方案,总结防治措施。 结果：本组942例患者发生出血性并发症共12例（1.27%）,其中术中出血9例、术后出血3例。9例术中出血无一例致死致残,其中因弹簧圈损伤瘤腔致动脉瘤破裂6例,微导管损伤瘤腔致动脉瘤破裂2例,微导丝损伤远端小分支导致出血1例。9例患者均预后良好,出院前mRS评分较入院时未增加。术后出血3例均死亡,其中2例蛛网膜下腔出血可能与瘤腔栓塞不全或术后肝素化有关,1例基底节区血肿可能与术后血压一过性增高有关。 结论：术前不常规应用抗血小板聚集药物及肝素化可降低术中出血导致的致死率,及时识别并处理后多数患者预后良好。术后出血发生率低,但预后差,病死率高。术前充分评估危险因素,术中致密填塞瘤腔,术后慎用抗凝治疗,可改善出血患者的预后。     

Endovascular treatment of proximal anterior cerebral artery aneurysms

Introduction  Aneurysms of the proximal segment of the anterior cerebral artery (A1A) are rare and challenging to treat. No information is available regarding their management by endovascular approach. The aim of this study was to report our experience with endovascular treatment (EVT) of A1As. Patients and methods  A retrospective review of our prospectively maintained database identified all A1As treated in our institution. The clinical charts, procedural data, and angiographic results were reviewed. Results  From April 2004 to August 2008, eight patients were identified and presented with an unruptured A1A. All aneurysms but one were <3 mm in diameter and two aneurysms had a perforator at the neck. Surgery was performed in two patients with an aneurysm <2 mm. Six patients were treated by selective embolization including five patients with balloon-assisted coiling (BAC) and/or via a retrograde approach from the contralateral side through the anterior communicating artery. These adjunctive techniques were used to safely catheterize the sac or to protect a branch at the neck. All patients showed an excellent clinical outcome. A complete aneurysm occlusion was obtained in all but one patient. Follow-up imaging in four patients showed stable results. Conclusion  EVT of A1As is feasible and associated with good clinical and anatomical results. Because of their location, small size, and close relationship with perforators, EVT frequently requires the use of BAC and/or a retrograde approach. Our results suggest that EVT is an alternative therapeutic option to surgical clipping if the aneurysm size is compatible with selective embolization.     

Initial primary endovascular treatment in the management of ruptured intracranial aneurysms: a prospective consecutive series

Introduction From January 1998 to December 2002, endovascular treatment (EVT) was used as first intention in all patients with ruptured aneurysms. The objective of this study was to analyze the results of this therapeutic strategy.Methods Among 401 patients admitted with a subarachnoid hemorrhage (SAH), 73 (18%) had a nonaneurysmal perimesencephalic SAH, 28 were not explored by angiography due to very poor clinical status, and 28 with aneurysmal SAH were not treated due to poor clinical status. Thus, of the 300 patients with a proven aneurysmal SAH, 272 (83%) were treated. EVT was attempted in 230 patients and was successful in 222 (82%), and clipping was performed in 50 (18%).Results Finally, EVT was successful in 234 aneurysms (96.7%) in 222 patients out of 242 aneurysms in 230 patients (some of the patients were treated for more than one aneurysm in the same procedure). EVT-related morbidity occurred in ten patients (4.5%) and mortality in eight (3.6%). Rate of dependency or death (modified Rankin scale 3–5) was 24.5% at 26 months. Initially, complete aneurysm occlusion was obtained in 81%, a dog ear in 3.4%, a neck remnant in 8% and incomplete occlusion in 8.1% of the patients. At follow-up (mean 26 months), the occlusion rate remained stable at 75%.Conclusion This consecutive prospective series shows that EVT can be performed routinely as first-intention treatment in most aneurysmal SAH. Using this therapeutic strategy, EVT was performed in 82% of patients with long-term clinical results similar to those of the ISAT study.     

Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome

Introduction We report imaging and clinical characteristics of patients with aneurysms that repeatedly reopened over time and were coiled three times or more during a follow-up period of 2–11 years. Methods At angiographic follow-up of 624 of 827 aneurysms coiled between 1995 and 2005, 74 aneurysms (8.9%) reopened and were additionally coiled. During an extended follow-up, 12 aneurysms (1.5%) in 12 patients repeatedly reopened and were repeatedly coiled. Initial aneurysm sizes ranged from 15 to 30 mm. Four aneurysms contained intraluminal thrombus. Eight aneurysms were associated with subarachnoid hemorrhage and two with a mass effect, and two were incidentally discovered. The locations of aneurysms were basilar artery (eight), carotid artery (two), anterior communicating artery (one) and middle cerebral artery (one). Results Altogether, 49 coil treatments were performed in the 12 aneurysms, ranging from three to six coil treatments per aneurysm. Of the 49 coil treatments, 20 (41%) were performed with a supporting device. There were no procedural complications (0%, 97.5% CI 0–5.7%). The mean clinical follow-up period was 70.6 months (median 60, range 25–135 months). All 12 patients are neurologically doing well (GOS 5). Reopening was by compaction in nine aneurysms and by migration of coils into intraluminal thrombus in three aneurysms. In two aneurysms, late regrowth became apparent at 76 and 95 months after the previous coiling. Conclusion Aneurysms that reopen over time and need to be coiled for a second time should be imaged at regular intervals to detect repeated reopening or regrowth. The treatment strategy of regular follow-up and additional treatments when necessary is effective and safe.     

A 6F guide sheath for endovascular treatment of intracranial aneurysms

Introduction Stable insertion of guide catheters via the femoral route can prove difficult because of tortuous vasculature leading to failure of endovascular treatment of intracranial aneurysms. Methods and results We report our experience using a long braided introducer sheath (6F Terumo Destination) with an inner diameter of 0.087 inches. It allowed the simultaneous use of multiple catheters or adjunctive techniques (balloon-assisted or stent-assisted coiling) while providing excellent support in 60 procedures involving coiling of anterior circulation aneurysms. Conclusion The use of a long introducer sheath, by enhancing stability in the aortic arch and supraaortic vessels, provides another solution to the problem of vascular tortuosity that hinders endovascular treatment of intracranial lesions.     

颅内动脉瘤血管内栓塞治疗分析

目的探讨颅内动脉瘤血管内栓塞治疗的手术时机、治疗方法、并发症及其预防措施。方法回顾性分析2009年7月~2012年7月在我院行颅内动脉瘤血管内栓塞治疗患者40例临床资料。另选同期进行开颅夹闭手术患者40例进行比较。结果经数字减影血管造影（DSA）检测结果显示,观察组与对照组在动脉瘤栓塞程度、术后并发症和随访结果上比较,差异均有统计学意义。结论血管内栓塞治疗颅内动脉瘤疗效切实可靠,安全、有效、微创,预后好,早期手术和及时术后处理是降低致残率、致死率的重要方法。     

Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms

Objective

The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms.

Methods

Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale.

Results

Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose.

Conclusion

The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.     

Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms

Introduction  Stent-assisted coiling (SAC) is an alternative to surgical clipping for the treatment of wide-necked intracranial aneurysms (IA). However, little information is available concerning the long-term results of this treatment. The aim of this study was to report the long-term clinical and anatomical findings in 32 patients with 34 wide-necked IA treated by SAC. Methods  A retrospective review of our prospectively maintained database identified all patients followed up for wide-necked IA treated by SAC. The clinical charts, procedural data, and angiographic results were reviewed. Results  Thirty-two patients with 34 IA were identified including 25 asymptomatic patients, four with cranial nerve palsies, two with a subarachnoid hemorrhage, and one with transient ischemic attacks. Mean aneurysm size was 10.2 mm (range 3.5 to 26 mm). Embolization was successful in all patients and no procedure-related neurological morbidity or mortality was observed. Immediate anatomical results included nine complete occlusions (26.5%), two neck remnants (6%), and 23 incomplete occlusions (67.5%). Mean imaging follow-up of 20 months showed 18 further thrombosis (53%) and 16 stable results (47%). Finally, 27 aneurysms were completely occluded (79%), three had a neck remnant (9%), and four were incompletely occluded (12%). Asymptomatic and nonsignificant in-stent stenosis occurred in seven patients (22%). Conclusions  SAC is safe and effective for the treatment of wide-necked IA. Despite unsatisfying immediate aneurysm occlusion, the adjunctive effect of the stent is stabilizing or significantly improving long-term anatomical results.     

血管内介入治疗老年患者颅内破裂动脉瘤研究进展

随着人们生活水平的提高及平均寿命的延长,我国已进入老龄化社会,老年人慢性病较多,相关疾病的诊断和治疗比较困难而且棘手。尤其在脑血管病方面,患者存在不同程度的血管硬化,且有长期服用阿司匹林或波立维等抗血小板聚集药物史,老年人颅内动脉瘤出血的发生率逐渐增加,严重威胁了老年人的身体健康和生活质量。本文就老年人颅内破裂动脉瘤血管内栓塞治疗的进展综述如下。     

Bilateral cavernous carotid artery aneurysms in a 4-year-old child: endovascular treatment with mechanically detachable coils

We present a 4-year-old child who suffered bilateral third nerve palsies secondary to bilateral giant saccular cavernous carotid artery aneurysms. Endovascular treatment was performed by means of direct endosaccular aneurysm occlusion on the right side and parent vessel occlusion on the left, using mechanically detachable coils. No complication occurred during or after the procedure. The bilateral third nerve palsies resolved over 3 months. Follow-up angiography at 1 year is presented. Received: 13 May 1996 Accepted: 9 August 1996     

Time-of-flight magnetic resonance angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils

The purpose of this study was to evaluate time-of-flight magnetic resonance angiography (MRA) in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils (GDCs). From January 1998 to January 2002 27 MRA and intra-arterial digital subtraction angiography (IADSA) examinations were analyzed for residual aneurysms and arterial patency following GDC placement. A total number of 33 intracranial aneurysms was analyzed, including 18 located in the posterior circulation. The MRA analysis was based on source images in combination with maximum intensity projections. The IADSA was used as the reference standard. Two aneurysms were excluded from evaluation, because of susceptibility artefacts from other aneurysms, which were clipped. Sensitivity and positive predictive values of MRA in revealing residual aneurysms were, respectively, 89% and 80%. Specificity in ruling out remnant necks and residual flow around coils was, respectively, 91% and 97%, with a negative predictive value of, respectively, 95% and 100%. Specificity and negative predictive value of MRA for arterial occlusion were, respectively, 87% and 100% for the parent arteries and, respectively, 85% and 100% for the adjacent arteries. MRA is a reliable diagnostic tool in the follow-up of GDC treatment, and it may replace IADSA in excluding residual flow around coils and aneurysmal necks and in ruling out arterial occlusion.No grant support. This paper was presented in whole at the following meetings: ECR, Vienna, March 2003; CIRSE, Lucerne, October 2002     

颅内动脉瘤的手术夹闭及血管内栓塞治疗

目的　探讨手术夹闭及血管内栓塞治疗颅内动脉瘤的适应证和治疗效果。方法　回顾性分析我科 1992～ 2 0 0 3年收治的 345例颅内动脉瘤患者的术前状况、动脉瘤的大小、形状、部位、治疗效果及脑血管造影 (DSA)的随访结果。结果　 2 36例行开颅夹闭手术 ,2 1例出现各种术后并发症 ,6例因术后出血再次手术 ;死亡 9例 ;87例术后 3个月或 6个月DSA复查 ,其中 3例因动脉瘤夹移位而再次手术夹闭。 10 3例行血管内栓塞治疗 ,4例出现一过性偏瘫或失语 ,经保守治疗后消失 ;6 3例不同时期DSA随访 ,6 2例动脉瘤栓塞良好 ,未再显影 ,1例动脉瘤复发 ,再次栓塞。 6例保守治疗 ,自动出院。结论　手术夹闭适合于动脉瘤位于前循环、因血管痉挛或解剖原因微导管不能到位的、瘤体小于 3mm动脉瘤 ;动脉瘤破裂发生危及生命的颅内血肿者 ,应手术清除血肿 ,同时夹闭动脉瘤。血管内栓塞适合大多数动脉瘤 ,尤为适合于动脉瘤位于后循环动脉瘤 ,随着Remodeling技术和颅内血管支架的应用 ,宽颈动脉瘤适合血管内栓塞 ,适应证越来越宽。对于两种方法的治疗效果的比较缺乏大宗病例的长期随访。     

Safety of endovascular treatment of intracranial aneurysms with a new,complex shaped Guglielmi detachable coil

Introduction The Guglielmi detachable coil (GDC) 360°, a new complex shaped bare platinum coil, became available in Europe for aneurysm treatment in September 2005. The purpose of this study was to assess the feasibility and safety of selective embolization of intracranial aneurysms with the GDC 360° in 52 consecutive patients. Methods All patients included in this study were registered in a prospectively maintained database. We assessed the patient clinical history, aneurysm shape and dimensions, technical details and complications of the procedures, degree of aneurysm occlusion, and clinical findings upon discharge. In all patients, the first coil deployed was a GDC 360°. Results Over a 6-month period, we intended to treat 52 aneurysms with the GDC 360° in 52 patients. Of these 52 patients, 42 (81%) were treated in the context of subarachnoid haemorrhage. In 51 of 52 patients, the underlying aneurysm was successfully treated by coil embolization. Six procedures (11.5%) were complicated by the formation of thrombus in the parent artery during the intervention. One patient suffered a stroke related to the procedure. Angiograms obtained immediately after the procedure showed complete occlusion of the aneurysmal sac in 38 of 51 procedures (74.5%), a neck remnant in 11 (21.6%), and a residual aneurysm in 2 (3.9%). In 43 of 51 patients (84.3%), clinical assessment demonstrated independent clinical status, whereas 7 patients (13.7%) required assistance in the activities of daily living upon hospital discharge. One patient (2.0%) died after development of a severe vasospasm 10 days after the endovascular procedure. Conclusion The GDC 360° can be safely used for the endovascular occlusion of intracranial aneurysms.     

Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion

Introduction Treatment of a dissecting aneurysm of the medullary segments of the posterior inferior cerebellar artery (PICA) usually entails trapping of the diseased arterial segment with possible sacrifice of brainstem perforators. The goal of the work was to review our experience with selective coiling of ruptured, dissecting aneurysms of the anterolateral segments of the PICA without parent vessel occlusion. Methods Eleven consecutive patients (9 women, 2 men, mean age 47.2 years) were retrospectively reviewed from a prospectively acquired neuroradiological database. On admission three patients had Hunt and Hess (HH) grade I, three HH grade II, two HH grade III, and one HH grade IV. Outcome was evaluated according to the modified Rankin scale (mRS) score. Follow-up (mean:19.4 months) consisted of magnetic resonance angiography and/or digital subtraction angiography in ten patients. Results Ten patients had mRS score 0 and one mRS score 2. No treatment failure occurred. The aneurysm was completely occluded in seven patients, a neck residue was present in two, and a loose coil mesh was present in two. Recurrence occurred in three patients, and all were successfully retreated for a total of 13 procedures. Procedure-related complications were all without clinical consequences and included a coil perforation in one procedure and stagnant filling of the parent vessel in six procedures. PICA occlusion did not occur in any patient. Conclusion Coiling of ruptured, isolated dissecting aneurysms of the PICA without parent vessel occlusion is feasible, relatively safe and effective in preventing early/medium-term rebleeding. A strict angiographic follow-up program is, however, necessary to detect recurrence.     

Internal carotid bifurcation aneurysms: frequency, angiographic anatomy and results of coiling in 50 aneurysms

INTRODUCTION: Internal carotid artery (ICA) bifurcation aneurysms are uncommon. Little is known about incidence, anatomical characteristics and results of endovascular treatment. We report our experience with endovascular treatment of 50 ICA bifurcation aneurysms in 46 patients. METHODS: There were 13 men (28%) and 33 women (72%) with a mean age of 49.3 years (range 23-76 years). Of 50 aneurysms, 26 (52%) were ruptured and 24 (48%) were unruptured. Of the 46 patients, 23 (50%) had one to five additional aneurysms. RESULTS: The frequency of ICA bifurcation aneurysms was 2.4% (53 of 2,249, 95% CI 1.8-3.1%). Their mean size was 9.6 mm (median 6 mm, range 2-55 mm). Aneurysm neck was symmetrically on A1 and M1 in 30 aneurysms (60%), dominant on A1 in 14 (28%), on M1 in 2 (4%) and on the ICA in 4 (8%). Aneurysm fundus projection was superior in 28 aneurysms (56%), posterior in 9 (18%), anterior in 10 (20%) and lateral in 3 (6%). Four aneurysms were coiled with balloon assistance. Procedural morbidity and mortality of coiling was 2% each. During follow-up, 7 of 50 aneurysms (all 10 mm or larger) were additionally treated (retreatment rate 14%). CONCLUSION: ICA bifurcation aneurysms are rare with a frequency of 2.4% of treated aneurysms in our institution. They are often associated with additional aneurysms. Most aneurysm necks are located symmetrically on A1 and M1 and fundus projection is mostly superior. Coiling is safe and effective for the management of these aneurysms. The aneurysms that needed retreatment were >/=10 mm.     

颅内动脉瘤的可脱性球囊栓塞治疗

目的：探讨可脱性球囊在颅内动脉瘤介入治疗中的价值及缺点,并探讨不同大小动脉瘤的栓塞技巧。方法：20例动脉瘤患者中,小动脉瘤8例（12mm）,大动脉瘤7例（12－25mm）,巨大动脉瘤5例（＞25mm）。15例患者行动脉瘤腔内直接栓塞治疗,6例行载瘤动脉闭塞。结果：14个采用球囊行瘤腔内栓塞的动脉瘤中,3个月后DSA随访,10个动脉瘤被完全栓塞,4个动脉瘤部分栓塞。6例采用球囊行载瘤动脉闭塞的动脉瘤患者,3个月DSA随访皆未见动脉瘤显影。结论：颅内大动脉瘤或巨大动脉瘤的可脱性球囊瘤腔内直接栓塞治疗是一种行之有效的治疗方法,外科不能手术或行瘤腔内直接栓塞治疗难度较大的某些动脉瘤,载瘤动脉的闭塞治疗仍不失为一种有效的治疗方法。     

合并动眼神经麻痹的颈内动脉后交通动脉段动脉瘤血管内治疗及预后分析

目的探讨合并动眼神经麻痹（oculomotor nerve palsy,ONP）的颈内动脉后交通动脉段动脉瘤的不同血管内治疗方式的恢复情况差异及影响因素。 方法回顾性分析我院2011至2018年收治的35例合并动眼神经麻痹的颈内动脉后交通动脉段动脉瘤并经血管内治疗的病例。随访观察术后动眼神经麻痹的恢复情况,分析不同治疗方式ONP恢复情况的差异性,分析术后数字减影血管造影（digital subtraction angiography,DSA）即刻评价的栓塞与否及程度对ONP恢复的差异性,分析ONP恢复与否与年龄、动眼神经麻痹程度、蛛网膜下腔出血（subarachnoid hemorrhage,SAH）、动脉瘤大小、自发病至接受治疗的时长的关系。 结果35例后交通动脉瘤患者,动眼神经麻痹完全恢复25例（71.4%）,部分恢复6例（17.1%）,未缓解4例（11.4%）;不同的血管内治疗方式,ONP的恢复没有统计学差异（P=1.00）;术后DSA即刻评价的栓塞与否及程度对ONP恢复的存在统计学差异（P<0.01）,单纯支架治疗和致密栓塞后动眼神经功能恢复得更好;年龄、ONP程度、动脉瘤大小、是否SAH、治疗时间均不是ONP恢复的影响因素（P>0.05）。 结论不同治疗方式患者的ONP恢复状态没有差异;术后即刻评价的致密栓塞及单纯支架置入,相较部分栓塞及栓塞后瘤腔显影,动眼神经恢复更好。     

Factors responsible for poor outcome after intraprocedural rerupture of ruptured intracranial aneurysms: identification of risk factors, prevention and management on 18 cases

Purpose

The paper mainly involved the retrospective approach to risk factors of intraprocedual rerupture (IPR) and illustration of our empirical prevention and management on this event as well as its postembolization outcomes evaluation.

Materials and methods

Endovascular treatment was performed in 1308 patients with 1308 ruptured intracranial aneurysms, and IPR occurred in 18 cases. We retrospectively reviewed their clinical records and images, and analysis risk factors of IPR by using multivariate logistic regression.

Results

The morbidity of IPR was 1.38% and mortality was 33.33%. Nine patients survived from rapid completion of coiling with immediate reversal of heparin anticoagulation with protamine sulfate, and 3 from emergent external ventricular drainage (EVD). However, 9 of them presented with different degrees of disability and 3 were fully recovered. Small aneurysms (diameter ≤ 3.0 mm) (OR 284.212, 95% C.I. 17.368–4650.780, P = 0.000), atherosclerosis (OR 7.866, 95% C.I. 1.113–55.570, P = 0.039), Fisher Grade III (OR 82.099, 95% C.I. 1.563–431.696, P = 0.029), vasospasm (grade I) (OR 32.269, 95% C.I. 2.393–435.132, P = 0.009) and vasospasm (grade II) (OR 30.238, 95% C.I. 1.770–516.552, P = 0.019) are risk factors of IPR. Aneurysms at proximal part of internal carotid artery (ICA), bifurcation and basilar artery (BA) stem (OR 0.003, 95% C.I. 0.000–0.101, P = 0.001) and Hunt and Hess Grade II (OR 0.010, 95% C.I. 0.000–0.346, P = 0.011) are identified as protective factors.

Conclusions

Small aneurysms, atherosclerosis, Fisher Grade of SAH and cerebral vasospasm are the predictors of IPR. Aneurysms at proximal part of ICA bifurcation and BA stem and Hunt and Hess Grade II are less associated with IPR. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation is confirmed to be the best strategy in our series.     

Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak.