This morning, a consultation with the surgeon Mr R at King's. I have to see him again in October after a scan, and he was emphasising again that following the EVAR procedure, its necessary to check the inserted piece of Dacron every few months to make sure that it isn't leaking where it joins the undamaged bits of the aorta itself. Mr R writes to my GP:

"I saw Lord Avebury today in my clinic. I am pleased to say that he has done extremely well following his EVAR operation two weeks ago. The plan is to see him again in two months' time with a duplex scan to make sure there is no endoleak from the operation......"

The literature actually defines five different possible types of endoleak:

• Type I - Perigraft leakage at proximal or distal graft attachment sites (near the renal and iliac arteries)
• Type II - Retrograde flow from collateral branches such as the lumbar, testicular and inferior mesenteric arteries
• Type III - Leakage between different parts of the stent (at the anastomosis between components)
• Type IV - Leakage through the graft wall due to the quality of the graft material
• Type V - Leakage from unknown origin

Its not clear from a superficial Google search what treatment there is for these complications. The University of Michigan says encouragingly:

"For the present, as a result of the major complications that endoleaks cause, one may conclude that endovascular treatment of AAA is still an evolving field. It is to be hoped in the future that better patient selection and improved devices will result from proper recording and appropriate analysis of clinical data".

This afternoon I cycled to Brixton for a meeting with senior staff at the Refugee Council. They are doing a great job supporting refugees in the community, with specialists for instance on the problems encountered by children and women.