Surgical Treatment of Endotension after Chimney Endovascular Repair of a Symptomatic Juxtarenal Aneurysm.

Endoleaks and persistent aneurysm sac expansion, also known as endotension, remain the Achilles heel of endovascular aneurysm repair (EVAR). The present article reports on a surgical treatment of 1 patient with endotension after chimney EVAR for a symptomatic juxtarenal aortic aneurysm. The surgical exploration revealed no signs of inflammation or infection and excluded any endoleak, confirming the term "endotension". After 1 year, the absence of sac expansion or endoleak was confirmed, with stable maximum diameter. Regarding therapeutic options, a nonoperative approach is recommended in asymptomatic patients. However, the management strategy for sac expansion without evidence of endoleaks as in case of endotension remains controversial.