Intra-operative contrast enhanced ultrasound as an adjunct to detect persistent type two endoleak after endovascular repair of abdominal aortic aneurysms

Endovascular stent grafting (EVAR) is an established treatment of abdominal aortic aneurysms. However, a major pitfall that undermines the long-term efficacy of EVAR is persistent type II endoleaks (T2E). Previously thought to be a benign phenomenon, emerging evidence from large registries suggest aneurysm sac non-regression/expansion, likely due to persistent endoleaks, to be associated with higher cardiovascular mortality and morbidity after treatment with EVAR (1,2). Novel methods to predict T2E after EVAR has potential clinical implications. Those prone to persistent T2E may be stratified towards more aggressive intervention, or, in select cases, be considered open surgical repair (OSR) instead.