Type 2 endoleak (T2EL) is the most common complication after endovascular aneurysm repair (EVAR), occurring in 10%–25% of patients. Although many T2ELs follow a benign course, persistent T2EL is associated with sac expansion, secondary endoleaks, rupture, and aneurysm-related mortality. Endovascular treatment is indicated in cases of progressive sac growth and is broadly divided into the transarterial approach and the direct sac puncture approach—the latter encompassing transabdominal, translumbar, and transcaval routes. Each approach has distinct technical advantages and limitations, and selection should be tailored to the source vessel of the endoleak, sac location, surrounding anatomy, and patient-related factors. Coils, N-butyl cyanoacrylate, and ethylene vinyl alcohol copolymer (Onyx) constitute the principal embolic agents, with liquid embolics showing improved durability over coils alone in recent comparative studies. Prophylactic embolization of the inferior mesenteric artery, lumbar arteries, or the aneurysm sac during EVAR has recently emerged as a promising preventive strategy. This review summarizes the current approaches, embolic materials, prophylactic strategies, and clinical outcomes of T2EL management from the perspective of the interventional radiologist.

Urologic trauma encompasses a spectrum of injuries involving the kidney, ureter, bladder, and urethra, with management strategies increasingly emphasizing organ preservation through minimally invasive, image-guided approaches. The updated American Association for the Surgery of Trauma 2025 grading system provides the most recent guideline for renal trauma classification, reflecting evolving imaging standards and management principles. In parallel, interventional radiology (IR) has assumed an increasingly important role in contemporary trauma care, offering effective, organ-preserving solutions through endovascular and percutaneous techniques. Renal trauma, the most frequent form of genitourinary injury, is now primarily managed non-operatively in hemodynamically stable patients, with transcatheter arterial embolization and stent-based repair serving as cornerstones of hemorrhage control and renal salvage in high-grade lesions. Clinical evidence demonstrates that selective or superselective embolization achieves high technical success and renal preservation, consolidating IR as a key component of multidisciplinary trauma management. Injuries to the lower urinary tract remain complex, but minimally invasive, image-guided interventions are increasingly recognized as integral to modern care, particularly in controlling hemorrhage and preserving function. Superselective embolization, percutaneous urine diversion, and fluoroscopic urethral realignment exemplify how IR provides life-saving, organ-preserving options for ureteral, bladder, and urethral trauma. Collectively, these developments underscore the expanding impact of IR across the full spectrum of urologic trauma management.