INTRODUCTION: Type II endoleaks (TIIEL) commonly occur following endovascular aneurysm repair (EVAR). There is a lack of unified consensus regarding the management of TIIEL. Pre-emptive embolization is a potential method to reduce the risk for TIIEL, but its role is debated. We performed a survey among aortic experts internationally to assess perspectives on TIIEL management and the role of pre-emptive embolization. METHODS: A questionnaire was prepared covering aspects on effect of TIIEL on EVAR outcome, strategies to manage TIIEL, and attitudes towards pre-emptive embolization techniques. The questionnaire was distributed using an online platform among vascular specialists across 80 specialized aortic centers worldwide. RESULTS: Of 80 survey recipients, 56 (70%) responded. Only 12% of participants did not believe TIIEL to affect the durability of EVAR. Nearly 82.2% of respondents believed TIIEL increases the likelihood of reintervention. One quarter agreed that TIIEL increases aortic-related mortality post-EVAR. For established TIIEL, 12% find "any sac expansion" to be an indication for intervention, whilst 41% would intervene at >
5mm sac expansion, and 52% at >
10mm sac expansion. Majority (63%) perform selective embolization in this setting. Only 3.6% of participants reported routinely conducting pre-emptive embolization in over 30% of their EVAR cases, while 42.9% never performed this procedure, and 53.6% performed pre-emptive embolization in <
30% of cases. A substantial 76.8% believed that existing literature lacked sufficient evidence to support the integration of pre-emptive embolization into their clinical practice. Additionally, almost 90% expressed interest in participating in a multicenter randomized controlled trial evaluating the safety and efficacy of pre-emptive embolization. CONCLUSIONS: Management of TIIEL is highly diverse among aortic experts. There is a need for further evidence on when and how to best treat TIIEL, as well as robust studies with long-term data to assess the potential role of pre-emptive embolization in increasing the durability of EVAR.