1. Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms 
Joseph J. Ricotta, MD 
Journal of Vascular Surgery 
Volume 52, Issue 4, Pages 91S-99S (October 2010)
DOI: /j.jvs
Copyright © 2010 Society for Vascular Surgery Terms and Conditions

2. Fig 1
Classification of endoleaks. A, The arrow points to a type Ia endoleak arising from the proximal attachment site. B, A type II endoleak arising from patent intercostals branch (arrow). Type III endoleaks arising from (C) disconnection between two endograft components (arrow) and (D) from a tear in the fabric of the endograft (arrow).
Journal of Vascular Surgery  , 91S-99SDOI: ( /j.jvs )
Copyright © 2010 Society for Vascular Surgery Terms and Conditions

3. Fig 2
Collapse of endograft resulting in a type Ia endoleak. A, B, Collapse of the proximal portion of the endograft (arrow) due to aggressive oversizing of the endograft to the aortic proximal sealing zone. C, Balloon angioplasty was initially attempted, which (D) successfully fully expanded the proximal portion of the endograft.
Journal of Vascular Surgery  , 91S-99SDOI: ( /j.jvs )
Copyright © 2010 Society for Vascular Surgery Terms and Conditions

4. Fig 3
Placement of Palmaz stent to treat type Ia endoleak. A, B, A balloon-expandable bare-metal Palmaz stent (Cordis Corp, Miami Lakes, Fla) was mounted on a balloon and successfully deployed within the proximal portion of the endograft. C, This provided enough radial force to sufficiently appose the endograft against the aortic wall and seal the endoleak.
Journal of Vascular Surgery  , 91S-99SDOI: ( /j.jvs )
Copyright © 2010 Society for Vascular Surgery Terms and Conditions

5. Fig 4
Technique for successful deployment of large Palmaz stent (Cordis Corp, Miami Lakes, Fla). A, After the appropriate stent and balloon are selected, the stent is hand-mounted on a collapsed valvuloplasty balloon and vigorously crimped with the thumb and forefinger to secure the stent to the balloon without bending it. B, The stent is carefully introduced into a long 16F to 20F sheath by pinching the proximal edge of the collapsed stent and balloon between the thumb and forefinger to avoid dislodgement of the stent from the balloon. C, It is not uncommon for the balloon to expand unevenly, causing the stent to unexpectedly migrate and “watermelon seed” off of the balloon proximally or distally during the deployment sequence. The sheath is carefully retracted to expose the entire balloon and stent and the balloon is gently inflated so as to minimally flare the proximal portion of the balloon and stent. The proximal portion of the balloon and stent are then withdrawn back into the sheath, exposing the distal portion of the balloon and stent. D, The balloon is then inflated, partially expanding only the unsheathed distal portion of the stent. This flaring of the unsheathed distal stent prevents “watermelon seeding” because the proximal portion of the balloon and stent that is located within the sheath does not deploy. Once the distal portion of the stent is fully flared and partially apposed along the aorta, the sheath is completely retracted to expose and allow the proximal portion of the balloon and stent to fully expand, permitting a uniform and accurate stent deployment.
Journal of Vascular Surgery  , 91S-99SDOI: ( /j.jvs )
Copyright © 2010 Society for Vascular Surgery Terms and Conditions

6. Fig 5
A, Placement of a proximal extension endograft component to repair a type Ia endoleak. B, Aortic arch debranching is performed to lengthen the proximal landing zone, and a proximal endograft extension component is deployed, partially covering the origin of the innominate artery C, Blood flow to the innominate artery is preserved by placement of a parallel snorkel stent-graft. D, This allows maximum endograft coverage of the lengthened proximal landing zone and successful sealing of the endoleak.
Journal of Vascular Surgery  , 91S-99SDOI: ( /j.jvs )
Copyright © 2010 Society for Vascular Surgery Terms and Conditions