ABSTRACT
Advances in medical and imaging technology in the 1990s has seen the introduction and rapid increase in the use of endoluminal stent grafting as an attractive and elegant alternative treatment modality for the treatment of aneurysm of the abdominal aorta (AAA) (1–6). This technology is much less invasive with reduced stress upon the patient, which is reflected in the 30-day mortality of 1.8% for 277 bifurcated endografts (7). The risk-benefit analysis of this procedure is determined more by the morphology of the aneurysm rather than by the fitness of the patient for surgery, success being determined by the ability of the device to immediately and permanently exclude the aneurysm chamber from the expansive forces of blood flow (6). Most endografts can be inserted with minimal stress under general anaesthetic, epidural, or even local anaesthetic: blood loss is minimal, ICU admission unnecessary, and postoperative care 80similar to hernia repair. Only successfully excluded aneurysms will diminish in size and cease to pose a risk of rupture (7). While the evolution of endoluminal technology warrants confidence in its future as an alternate treatment modality for aneurysm repair, fundamental questions remain about the long-term safety and efficacy of these devices (4). The term endoleak was coined by Geoff White to describe the observation of flow within the sac of an aneurysm through which an endoluminal graft had been placed (8). Its important implication is that the aneurysm sac is still pressurized to a greater or lesser extent. It is a subset of pressurized aneurysm sacs following endoluminal grafting. If flow is detected, pressure is implied, and until recently this was the only method of verifying continued pressurized aneurysms. An endoleak, being a mark of failure of objective, is the Achilles’ heel of endoluminal grafting.
