ABSTRACT
It is assumed that endovascular repair changes the natural history of aortic aneurysm by excluding the aneurysm from the circulation and protecting its walls from pressure, thereby preventing dilatation and rupture. Freedom from continued aneurysm perfusion is therefore regarded as an indicator of successful endovascular aneurysm repair. The occasional case of aneurysm rupture in the absence of endoleak (1–3) shakes these assumptions and deprives us of a reliable surrogate goal. This consensus conference is part of the academic response to the resulting discomfort. However, the subject is broader than the title would suggest. Our subject is not endoleak, but the efficacy of endovascular aneurysm repair, and we are unlikely to achieve real consensus until we understand the behavior of a new form of arterial pathology, the graft-lined aortic aneurysm.
