ABSTRACT
Development of endoluminal techniques for aneurysm repair has been accompanied by previously unencountered complications. The most interesting and demanding of these are incomplete seal of the endovascular graft (“endoleak”) and persistent growth or pressurization of the aneurysm sac without extragraft blood flow (“endotension”). The defining factor for endoleak is thus blood flow, whereas endotension implies growth or pressure without blood flow. Both of these phenomena may be due to misplacement or poor sizing of the endovascular graft device (technical error), may be the result of material fatigue, displacement, or distortion (device failure), or may be precipitated by specific reactions to the graft device within the environment of the aneurysm sac (patient factors). Endoleak has been perceived as the Achilles’ heel of endovascular technology—the incidence and severity of this complication and its relationship to long-term procedure outcome will influence to a great degree the eventual acceptance of the endovascular repair technique.
