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Endovascular Stenting

Endovascular stenting, open sur- gical superior mesenteric artery bypass, and/or surgical thrombec- tomy may be needed for reperfu- sion.9 Prognosis for these patients is grave and often results in hos- pital death.

Endoleak. Endoleak is a complication of TEVAR that can happen at any time. It is defined as the persistence of blood flow outside the lumen of the graft in a segment treated by the graft, as determined by an imaging study.34 Incidence ranges from 5% to 25% at 30 days and 4% to 28% at 1 year with about 46% requiring additional treatment endovascularly.35 (See Types of endoleak.)

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Types I and II are considered “high pressure” and require intervention. The presence or absence of an enlarging aneu- rysm sac strongly influences the decision to pursue or not pursue treatment.9 Type III endoleak is currently less common due to the improvements in grafts used today. A defective device, damage during delivery or balloon manip- ulation, or constant wear of the fabric against the endograft wires indicates the need for another endograft.

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