ABSTRACT
Endoluminal repair of infrarenal abdominal aortic aneurysms (AAA) has become an accepted treatment option for patients with suitable vascular anatomy. Unfortunately, the goal of excluding the aneurysm sac from blood flow is not always achieved. The presence of blood flow outside the lumen of an endovascular graft but within the aneurysm sac or adjacent vascular segments being treated has been termed endoleak and implies some degree of maintained pressurization of the aneurysm sac (1). While some endoleaks (especially types II and III) represent an unexpected sequella of endografting aortic aneurysms, the mechanism of formation is conceptually simple. Contrarily, the mechanism of another new concept, endotension, remains obscure. Endotension refers to the persistent pressurization of the aneurysm sac in the absence of a detectable endoleak (2). Understanding the role of endoleak and endotension in the success or failure of endoluminal aneurysm repair is one of the major challenges facing endovascular specialists.
