News from the FDA/CDC

FDA warns of endoleaks associated with endovascular grafts for AAA


Key clinical point: Patients treated with EVAR should have lifelong monitoring.

Major finding: FDA monitoring sources have detected an apparent increase in the occurrence of Type III endoleaks following EVAR.

Data source: FDA’s Medical Device Reporting System and the Annual Clinical Updates to Physicians by the manufacturers.

Disclosures: None.


The Food and Drug Administration has reported an apparent increase in device-related adverse events from the use of endovascular graft repair (EVAR) to treat abdominal aortic aneurysms (AAA).

In a Letter to Health Care Providers issued on Sept. 28, the FDA indicated that “recent information from several sources, including FDA’s Medical Device Reporting system and Annual Clinical Updates to Physicians by the manufacturers, suggests an increase in the occurrence of Type III endoleaks.”

A Type III endoleak is defined by the failure to completely exclude the AAA from blood flow, thereby allowing a systematic arterial pressurization of the aneurysm sac, increasing the risk of rupture, which is a life-threatening event.

The FDA stated that predictors of Type III endoleaks included treatment with early-generation graft materials, the presence of calcified plaque, and inadequate overlap between graft components.

Secondary interventions to treat Type III endoleaks carry their own risk of adverse events.

It is recommended that health care providers should do the following:

  • Consider lifelong surveillance of patients who have been treated with EVAR.
  • Consider type III endoleaks in the differential diagnosis of patients who present with symptoms of potential aneurysm expansion or rupture.
  • Discuss all treatment options in depth with patients before deciding on the best treatment for Type III endoleaks.
  • Report any early or late device-related adverse events, including Type IIIa and Type IIIb endoleaks, associated with EVAR, as well as any device-related adverse events that occur as the result of a secondary intervention to treat Type III endoleaks.

These events should be reported to MedWatch, using the FDA’s Safety Information and Adverse Event Reporting Program Online Voluntary Reporting Form. A form also can be requested by calling 800-332-1088.

The FDA stated that it “continues to work with all manufacturers of endovascular graft systems to better understand this issue,” and that the agency would keep the public informed when significant new information becomes available.

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