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Y N Classification of endoleak types Type Ia Type Ib Type II Type III Type IV Type V Surveillance after TEVAR/EVAR and management of endoleaks CCT and DUS/CEUSa at 1 month and 1 year post-op No new endoleak Type I or type III endoleak Consider re-intervention (Class I) Type II endoleak Detected at 1 month post-op CCT re-evaluation at 6–12 months Annual surveillance with CCT or DUS/CEUSa for the first 5 years <10 mm or shrinking Consider open surgery, if growing aneurysm sac CCT or DUS/CEUSa surveillance every 6 months for 24 months New endoleak or growing aneurysm sac CCT, or non-contrast CCT with DUS/CEUS every 5 yearsa Growing aneurysm sac Consider embolization, if feasible (Class IIa) CCT Proceed to endoleak type CCT or DUS/CEUSa surveillance at 6–12 months New endoleak ≥10 mm Y N Figure 27 Algorithm for follow-up after thoracic endovascular aortic aneurysm repair, and management of endoleaks and their classification. CEUS, contrast-enhanced ultrasound; CCT, cardiovascular computed tomography; DUS, duplex ultrasound; TEVAR, thoracic endovascular aortic aneurysm repair; EVAR: Endovascular aortic repair. aIn cases of TEVAR, CCT is the preferred imaging technique since DUS/CEUS does not permit the correct evaluation of the thoracic aorta. In cases of renal failure, non-contrast CCT is a good alternative to monitor aneurysm sac growing and is associated to DUS/CEUS for EVAR monitoring. Endoleaks are classified into five types: Type Ia, proximal attachment site endoleak; Type Ib, distal attachment site endoleak; Type II, backfilling of the aneurysm sac through branch vessels of the aorta; Type III, graft defect or component misalignment; Type IV, leakage through the graft wall attributable to endograft porosity; and Type V; caused by ‘endotension’, possibly resulting from aortic pressure transmitted through the graft/thrombus to the aneurysm sac. Adapted from Rokosh et al. with permission.1147 Downloaded from academic.oup.com/eurheartj/article/45/36/3538/7738955 by guest on 07 October 2026