A 55-year-old woman undergoes endovascular aneurysm repair (EVAR) for a 5.8 cm infrarenal AAA. At the 6-month surveillance CT, contrast is identified outside the graft but within the aneurysm sac, with no visible source on the initial scan. Which type of endoleak is this?

• A Type I endoleak
• B Type II endoleak
• C Type III endoleak
• D Type V endoleak (endotension) ✓

Explanation

Type V endoleak, or endotension, describes continued sac expansion after EVAR without a visible endoleak on imaging. The sac expands despite no demonstrable contrast leak. Type I is a seal failure at the graft ends (proximal or distal). Type II is retrograde flow from branch vessels (lumbar or inferior mesenteric). Type III is a defect in the graft fabric or junctional separation. Type IV is graft wall porosity, largely historical with modern grafts.

Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.