Type I endoleak following endovascular aortic aneurysm repair (EVAR) is defined as:
- A Persistent perigraft flow from inadequate seal at the proximal or distal graft attachment zones ✓
- B Retrograde flow from patent aortic branch vessels (lumbar arteries or inferior mesenteric artery)
- C Structural failure of the graft fabric allowing flow through the graft material
- D Flow between overlapping modular graft components
Correct answer: A. Persistent perigraft flow from inadequate seal at the proximal or distal graft attachment zones
Explanation
Type I endoleak represents failure of seal at the graft attachment zones: Type Ia (proximal attachment zone) and Type Ib (distal attachment zone). This is the most clinically significant endoleak as it allows pressurisation of the aneurysm sac under systemic pressure, risking continued expansion and rupture. It requires prompt intervention (balloon moulding, Palmaz stent, proximal extension, or open conversion). Type II endoleak is branch vessel backfill (option B). Type III is modular disconnection or fabric tear (options C/D combined). Type IV is fabric porosity.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.