Endoleaks are the most common problem following endovascular aneurysm repair. The importance of a type II endoleak has often been subject of discussion in scientific literature. Conflicting data on the natural history of type II endoleak have been published. There is no consensus on the threshold for treatment of type II endoleak and controversy exists about the optimal treatment modality. This paper discusses the evidence behind treating type II endoleak and investigates the need for treatment.