Successful management of endoleaks after endovascular aneurysm repair (EVAR) continues to be a topic of much discussion, controversy, and exploration. EVAR has been performed for a decade, but we are just now beginning to learn about the physiology within the aneurysm sac after a stent graft has been placed. By studying the sac after endograft placement, we hope to establish measurable and accurate prescreening processes. This will allow the interventionalist to predict which patients will encounter problems after EVAR.

During the last several years, we have learned a tremendous amount about endoleaks, their causes, and various treatments options. We also have a better understanding of which endoleaks need immediate treatment and which should be monitored. However, the relationship between endoleaks and aneurysm enlargement and rupture remains vague. This is a question that may never be answered, but hopefully we will be able to treat those patients who are at risk and prevent endoleaks from occurring in the first place.

This issue of Endovascular Today highlights various topics concerning the management of endoleaks after EVAR. Ross Milner, MD, writes about the future utility of remote pressure monitors. Mark Fillinger, MD, discusses the initiation of a multicenter study to evaluate abdominal aortic aneurysm wall stress. You will also find articles about the diagnosis and treatment of endo-leaks, as well as an article dealing with the possible reasons for aneurysm sac shrinkage, or lack thereof.

Additionally, Mark Burket, MD, describes an interesting Challenging Case in which an SVC rupture was treated by means of an endovascular graft system; David E. Allie, MD, describes two useful techniques; and John Ross, MD, presents a method for optimizing catheter tip positioning. I hope that you find these topics informative and stimulating, and as always, Endovascular Today welcomes your feedback and ideas.