# Endoleak — Endoleak classification after EVAR

> Classifies persistent aneurysm-sac perfusion after endovascular aneurysm repair by source.

**Situação:** vigente · **Órgão:** Vascular · **Órgão emissor:** Vascular surgery consensus · **Versão:** current · **Ano:** 2023

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT, US, Angiography
- Fonte primária: Yanamaladoddi VR, Sarvepalli SS, Vemula SL, et al.. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10312356/
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Type I, attachment-site leak | Inadequate seal at a graft attachment site lets blood track alongside the graft into the aneurysm sac. Subtype Ia is a proximal attachment-site leak; subtype Ib is a distal attachment-site leak. | Generally prompt intervention. Type Ia: balloon molding, a proximal cuff or stent, chimney or fenestrated EVAR, anchors, or embolization. Type Ib: distal graft extension. Open conversion if endovascular repair fails. | High rupture risk from continued sac pressurization and expansion. | PMC10312356 (Yanamaladoddi et al., Cureus 2023), 'Type I Endoleaks'; corroborated by StatPearls NBK554573 'Abdominal Aortic Repair', Complications. | ✓ |
| II | Type II, branch-vessel backflow | Retrograde (collateral) backflow into the aneurysm sac from aortic side branches, chiefly the lumbar arteries and the inferior mesenteric artery; the most common type overall. | Often observed; treated when the sac enlarges (about 5 mm or more over roughly 6 months) by transarterial, translumbar/direct-sac, or transcaval embolization, or surgical feeder ligation as an alternative. | Relatively benign; many resolve within about 6 months, but roughly 55% show sac enlargement within 3 years if persistent beyond 6 months. | PMC10312356, 'Type II Endoleaks'; corroborated by StatPearls NBK554573, Complications. | ✓ |
| III | Type III, graft defect or component separation | Mechanical graft failure perfusing the sac. Subtype IIIa is separation or disconnection between graft components (junctional); subtype IIIb is a fabric defect, tear, or hole. | Prompt intervention: endovascular relining with additional graft component(s) bridging or overlining the defect; open conversion if needed. | High rupture risk, comparable to type I. | PMC10312356, 'Type III Endoleaks'; corroborated by StatPearls NBK554573, Complications. | ✓ |
| IV | Type IV, graft porosity | Blood seeps through the inherent porosity of the graft fabric, with no discrete defect; usually seen early after implantation. | Usually transient and self-limiting; observation, rarely requiring intervention with modern devices (treatment generally not recommended). | Low-flow leak with minimal rupture risk; typically resolves once coagulation normalizes. | PMC10312356, 'Type IV Endoleaks'; risk and 'treatment not recommended' per Society for Vascular Surgery patient guideline (vascular.org 'Endoleaks (Type I-V)') and SVS clinical practice guidelines (J Vasc Surg endoleak management). | ✓ |
| V | Type V, endotension | Continued aneurysm-sac enlargement after EVAR with no demonstrable endoleak; a diagnosis of exclusion, also called endotension. | Surveillance, with intervention (graft relining or open conversion) suggested for ongoing sac expansion even without a visible endoleak. | Low risk in the short term, but continued sac enlargement confers a long-term aneurysm-rupture risk and usually warrants repair. | PMC10312356, 'Type V Endoleaks'; risk and management per Society for Vascular Surgery patient guideline (vascular.org 'Endoleaks (Type I-V)') and SVS clinical practice guidelines (J Vasc Surg endoleak management, grade 2C). | ✓ |

### Citações por categoria
- **I**: Yanamaladoddi VR, Sarvepalli SS, Vemula SL, et al.. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10312356/ · PMC10312356 (Yanamaladoddi et al., Cureus 2023), 'Type I Endoleaks'; corroborated by StatPearls NBK554573 'Abdominal Aortic Repair', Complications.
- **II**: Yanamaladoddi VR, Sarvepalli SS, Vemula SL, et al.. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10312356/ · PMC10312356, 'Type II Endoleaks'; corroborated by StatPearls NBK554573, Complications.
- **III**: Yanamaladoddi VR, Sarvepalli SS, Vemula SL, et al.. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10312356/ · PMC10312356, 'Type III Endoleaks'; corroborated by StatPearls NBK554573, Complications.
- **IV**: Yanamaladoddi VR, Sarvepalli SS, Vemula SL, et al.. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10312356/ · PMC10312356, 'Type IV Endoleaks'; risk and 'treatment not recommended' per Society for Vascular Surgery patient guideline (vascular.org 'Endoleaks (Type I-V)') and SVS clinical practice guidelines (J Vasc Surg endoleak management).
- **V**: Yanamaladoddi VR, Sarvepalli SS, Vemula SL, et al.. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10312356/ · PMC10312356, 'Type V Endoleaks'; risk and management per Society for Vascular Surgery patient guideline (vascular.org 'Endoleaks (Type I-V)') and SVS clinical practice guidelines (J Vasc Surg endoleak management, grade 2C).


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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