Periaortic inflammation after endoleak repair: a risk to watch

PURPOSE: To evaluate the occurrence of periaortic inflammation, including abscess formation, as a complication following endoleak repair after endovascular aortic repair. MATERIALS AND METHODS: This retrospective single-center study analyzed 88 EVAR revisions for endoleak treatment performed in 59 patients between 2015 and 2025. Patients underwent one to three revision procedures. Endoleaks were classified by type, and treatment was performed via transarterial access or direct sac puncture with a posterior/translumbar access route. Embolization materials for type II endoleaks included n-butyl-2-cyanoacrylate, ethylene vinyl alcohol, and coils, while stent-graft extensions and transmural fixation were used for type I and III endoleaks. RESULTS: Of the 59 patients, 38 (64.4%) underwent one revision, 13 (22.0%) two revisions, and 8 (13.6%) three revisions. Treated endoleaks included type I (19.3%), type II (77.3%), type III (2.3%), and combined type II/III (1.1%). A total of 73 procedures (83.0%) were performed via transarterial access and 15 (17.0%) via direct sac puncture. Follow-up CT identified 6 cases of periaortic inflammation after type II endoleak repair, presenting with soft tissue mantle, fat stranding, or abscess formation. Symptom onset ranged from 33 to 108 days after the most recent intervention. No significant association was found between periaortic inflammation and access route or embolic material. CONCLUSION: Periaortic inflammation and abscess formation are possible severe complications after endoleak repair following endovascular aortic repair. To date, these inflammatory changes have not been described systematically in the literature and warrant further investigation.