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Vascular Medicine
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review-article

Endotension following endovascular aneurysm repair

Naoki Toya

Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan

Tetsuji Fujita

Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan

Yuji Kanaoka

Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan

Takao Ohki

Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan takohki{at}msn.com

Abstract

Endovascular aneurysm repair (EVAR) is a new and minimally invasive alternative to open repair for patients with abdominal aortic aneurysm (AAA). Soon after its introduction in 1990, it was recognized that EVAR had potential and distinct advantages in the elective and emergency settings. However, long-term follow-up has shown enlargement of the AAA in a substantial percentage of patients who underwent EVAR with the original-permeability Excluder. Of interest is that sac expansion frequently occurs in the absence of endoleak, often referred to as endotension. The pathophysiology of endoleak is beginning to be elucidated and its management is ready to be established, while controversy still exists about the etiology and clinical consequences of endotension. Fortunately, the incidence of endotension is decreasing and it appears that AAA expansion after EVAR with the original Excluder can be arrested by endovascular relining with a low-permeability Excluder endoprosthesis. The aim of this brief review is to provide historical perspective and a good understanding of the etiology, diagnosis, and management of endotension.

Key Words: endoleak • endotension • endovascular aneurysm repair • low-permeability intra-aneurysmal pressure • pressure sensor

Vascular Medicine, Vol. 13, No. 4, 305-311 (2008)
DOI: 10.1177/1358863X08094850
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