Type 3 endoleak following endovascular abdominal aortic aneurysm repair

Endovascular aneurysm repair (EVAR) is a frequently used method for aneurysm repair, with benefits including lower early morbidity and mortality, earlier discharge from hospital and less blood loss. Patients with EVAR may however have a higher re‐intervention rate than conventional open surgery1-3 due to complications that are specific to EVAR. Endoleaks are one such complication, causing ongoing blood flow within an aneurysmal sac. Type 1 endoleaks develop from poor apposition between one or more attachment sites of the graft and native vessel causing a high‐pressure leak into the aortic sac; type 2, the commonest type of endoleak, is caused by retrograde flow of blood from small tributaries into the sac and is generally considered benign. Type 3 endoleaks, a high‐risk and high‐pressure leak, is caused by separation of or a defect in graft components, and type 4 endoleaks are due to graft porosity and usually spontaneously settle.4 Type 1 and 3 endoleaks are uncommon but may lead to aneurysm rupture4 and need to be investigated and treated with urgency.