Effective management of type II endoleak post EVAR: A multidisciplinary approach by nurses

Asha

Clinical Instructor, Kauvery Hospital, Alwarpet, Chennai

Introduction

A 70-year-old male patient, was admitted to the hospital with a diagnosis of type II endoleak through the inferior mesenteric artery (IMA) post-endovascular aneurysm repair (EVAR). This case study will discuss the patient’s presentation, management, and nursing care.

Definition

Type II endoleak is a complication of EVAR, characterized by the retrograde flow of blood into the aneurysmal sac through collateral vessels, such as the IMA.

Case Presentation

Presented with a prominent abdominal pulsation and was diagnosed with type II endoleak through IMA on CT angiography. He underwent IMA embolization on 22.09.2025.

Review of Literature

Type II endoleak is a common complication of EVAR, occurring in up to 20% of patients. It is often asymptomatic but can lead to aneurysmal sac expansion and rupture. IMA embolization is a minimally invasive procedure used to treat type II endoleak.

Signs and Symptoms

The patient presented with a prominent abdominal pulsation. Other signs and symptoms of type II endoleak may include:

  • Abdominal pain
  • Back pain
  • Decreased ankle-brachial index (ABI)

Diagnostic Evaluation

The patient underwent CT angiography, which showed type II endoleak through IMA. Other diagnostic tests may include:

  • Ultrasound
  • MRI
  • Angiography

Evidences

Post EVAR

Management

The patient underwent IMA embolization on 22.09.2025. Other management options for type II endoleak may include:

  • Watchful waiting
  • Embolization of collateral vessels
  • Open surgical repair

Surgical Management

IMA embolization was performed through a minimally invasive approach. The procedure involved:

  • Right femoral artery puncture and cannulation
  • SMA entry using Terumo wire and cobra catheter
  • Microcatheter introduction and IMA embolization using coils

Nursing Interventions

  • Monitored vital signs and hemodynamic stability
  • Administered pain management and anticoagulation therapy as ordered
  • Provided wound care and dressing changes
  • Educated the patient on post-procedure care and follow-up appointments

Nursing Diagnosis

  • Risk for bleeding related to anticoagulation therapy
  • Pain related to procedural discomfort
  • Anxiety related to uncertainty about the procedure and outcome

Patient Appreciation Feedback

The patient expressed satisfaction with the care provided and appreciated the explanations and education given by the nursing staff.

Evaluation

The patient’s outcome was evaluated based on:

  • Hemodynamic stability
  • Pain management
  • Wound healing
  • Patient satisfaction

Conclusion

This case study highlights the importance of prompt recognition and management of type II Endoleak post-EVAR. The patient underwent successful IMA embolization and received comprehensive nursing care. The patient’s outcome was satisfactory, with no complications noted during the hospital stay.

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