Individuals who undergo endovascular aneurysm repair (EVAR) require lifelong surveillance to discover potential endoleaks and receive timely corrective treatment. Endoleaks are classified into five categories based on the direction of blood flow in the aneurysm sac outside the graft and this classification determines clinical consequence and treatment. CT scanning is currently viewed as the gold standard for endoleak monitoring. However, this practice exposes patients to nephrotoxic IV contrast as well as high and cumulative doses of radiation. Ultrasonography offers a non-invasive and cost-effective alternative to CT monitoring of endoleaks.

This pictorial review provides ultrasound and corresponding CT images of each of the five subtypes of endoleak, thereby illustrating the effectiveness of duplex ultrasound in screening for potential endoleaks post-EVAR.  In an effort to reduce risk of nephrotoxicity and radiation exposure, the use of duplex ultrasound as a long term screening modality for post-EVAR surveillance can become the new standard of care.

Endovascular Aneurysm Repair (EVAR) – A Multi-Modality Pictorial Review of Endoleaks