American Board of Surgery Qualifying Exam (ABS QE) Practice Test

What is the recommended treatment for a Type 2 endoleak?

1. Immediate surgical intervention

2. Embolization or observation

3. Replacement of the stent graft

4. Extension of the cuffs

The correct answer is: Embolization or observation

The recommended treatment for a Type 2 endoleak is embolization or observation. Type 2 endoleaks occur when blood flow is redirected into the aneurysm sac through collateral circulation, often from nearby arteries such as lumbar or inferior mesenteric arteries. In many cases, Type 2 endoleaks are stable and may not pose an immediate risk to the patient. The natural history of these endoleaks often shows that they can resolve spontaneously over time without intervention. Therefore, careful observation with regular imaging follow-up is a common approach, especially if the endoleak is not causing any symptoms or significant enlargement of the aneurysm sac. If the endoleak leads to clinical symptoms or demonstrates expansion of the aneurysm sac, embolization can be performed to occlude the vessels supplying the aneurysm. This minimally invasive procedure involves placing materials such as coils or glue into the feeding vessels to halt the blood flow, thereby preventing further complications. Immediate surgical intervention, replacing the stent graft, or extending the cuffs are more aggressive measures typically reserved for more complicated cases or for other types of endoleaks that do not resolve with observation. Hence, the best practice for a Type 2 endoleak is to either monitor the situation closely or