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Some patients may be followed every 2 years, especially in the setting of a shrinking sac in the absence of an endoleak.

Patients with renal insufficiency may be followed with duplex ultrasound and noncontrast CT.

Furthermore, filling of the IMA or lumbar arteries on cross-sectional imaging does not always represent a type II endoleak; we have seen many patients who have a subtle type Ia endoleak with resultant antegrade flow in these vessels (inflow from the proximal attachment zone and outflow from the lumbar/IMA), which is best appreciated on aortography.

At Miami Cardiac and Vascular Institute, type II endoleaks are only treated if there is evidence of aneurysm growth (generally 5 mm).

Less common sources of type II endoleaks include accessory renal and median sacral arteries.

Stable access in the SMA or internal iliac artery is the first important step in performing transarterial embolization.

A three-phase scan consisting of a noncontrast scan, an arterial phase, and delayed imaging is essential, and review of previous studies is mandatory.

Once an endoleak is identified, it is critical to determine the endoleak type in order to guide management.

Time-resolved magnetic resonance angiography is used selectively at our center, sometimes to better determine the flow dynamics of an endoleak seen on CTA.

It is critical that a proper imaging protocol is utilized for cross-sectional imaging after EVAR to ensure that endoleaks are identified.

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