A 70 yo M w/ a PMHx of HTN and DM presents to the ED with chest pain. He is 1 month s/p TEVAR with graft placement for a type B aortic dissection. A CTA is obtained. What's the diagnosis? (scroll down for answer) 

Answer: Type I Endoleak at proximal graft site

• Endoleak = persisent blood flow outside of graft following aortic repair
• Note plume of contrast on image above in false lumen proximal to graft
• Often asymptomatic and can occur at any time post graft placement
• Found in 20-40% of patients, thus CTs recommended at 6 month intervals following repair
• CTA is gold standard for diagnosis
• Classified as
• Type I: proximal or distal to graft; usually require surgical intervention
• Type II: (most common) occur when blood flows into aneursym sac from branch vessels; may resolve spontaneously
• Type III: due to leaking through graft defect (mechincal failure of graft); requires repair
• Type IV: due to leaking through fabric of graft; may resolve spontaneously
• Type V: endotension: not a true leak; continued expansion of aneurysm site without radiographic evidence of leak 
• Vascular surgery was consulted immediately and patient was admitted to ICU setting for strict BP control 

References:

Rosen RJ, Green RM. Endoleak management following endovascular aneurysm repair. J Vasc Interv Radiol. 2008;19 (6 Suppl): S37-43.