Vascular surgery: endoleak after EVAR: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Vascular surgery: endoleak after EVAR

Sample item

Surveillance CT angiography one month after endovascular aneurysm repair shows contrast filling the sac through retrograde flow from a lumbar artery. The sac diameter is stable and the patient is asymptomatic. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Continued imaging surveillance

A type II endoleak is retrograde flow into the sac through branch vessels such as lumbar arteries or the inferior mesenteric artery, and is the commonest endoleak. Many seal spontaneously, so with a stable sac they are observed, and embolisation is reserved for sac growth. Type I (attachment site) and type III endoleaks transmit systemic pressure and need prompt correction.

Option by option

  • A. Continued imaging surveillance (correct)

    Correct. A stable sac with a type II leak is watched, with embolisation if it enlarges.

  • B. Immediate conversion to open repair

    Open conversion carries high risk and is not required for a stable type II leak.

  • C. Lifelong warfarin

    Anticoagulation does not treat an endoleak and may encourage persistence.

  • D. Urgent proximal cuff extension

    Cuff extension treats a proximal attachment site (type I) leak.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Continued imaging surveillance. A type II endoleak is retrograde flow into the sac through branch vessels such as lumbar arteries or the inferior mesenteric artery, and is the commonest endoleak.

Why is "Immediate conversion to open repair" not the answer?

Open conversion carries high risk and is not required for a stable type II leak.

Why is "Lifelong warfarin" not the answer?

Anticoagulation does not treat an endoleak and may encourage persistence.

Why is "Urgent proximal cuff extension" not the answer?

Cuff extension treats a proximal attachment site (type I) leak.

What concept does this question test?

It tests Vascular surgery: endoleak after EVAR in General Surgery. Many seal spontaneously, so with a stable sac they are observed, and embolisation is reserved for sac growth. Type I (attachment site) and type III endoleaks transmit systemic pressure and need prompt correction.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vascular surgery: endoleak after EVAR?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.