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Almansour H, Mustafi M, Lescan M, Grosse U, Andic M, Schmehl J, Artzner C, Grözinger G, Walter SS. Dynamic Radial MR Imaging for Endoleak Surveillance after Endovascular Repair of Abdominal Aortic Aneurysms with Inconclusive CT Angiography: A Prospective Study. J Clin Med 2024; 13:2913. [PMID: 38792455 PMCID: PMC11122363 DOI: 10.3390/jcm13102913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: To assess free-breathing, dynamic radial magnetic resonance angiography (MRA) for detecting endoleaks post-endovascular aortic repair (EVAR) in cases with inconclusive computed tomography angiography (CTA). Methods: This prospective single-center study included 17 participants (mean age, 70 ± 9 years; 13 males) who underwent dynamic radial MRI (Golden-angle RAdial Sparse Parallel-Volumetric Interpolated BrEath-hold, GRASP-VIBE) after inconclusive multiphasic CT for the presence of endoleaks during the follow-up of EVAR-treated abdominal aortic aneurysms. CT and MRI datasets were independently assessed by two radiologists for image quality, diagnostic confidence, and the presence/type of endoleak. Statistical analyses included interrater and intermethod agreement, and diagnostic performance (sensitivity, specificity, area under the curve (AUC)). Results: Subjective image analysis demonstrated good image quality and interrater agreement (k ≥ 0.6) for both modalities, while diagnostic confidence was significantly higher in MRA (p = 0.03). There was significantly improved accuracy for detecting type II endoleaks on MRA (AUC 0.97 [95% CI: 0.87, 1.0]) compared to CTA (AUC 0.66 [95% CI: 0.41, 0.91]; p = 0.03). Although MRA demonstrated higher values for sensitivity, specificity, AUC, and interrater agreement, none of the other types nor the overall detection rate for endoleaks showed differences in the diagnostic performance over CT (p ≥ 0.12). CTA and MRA revealed slight to moderate intermethod concordance in endoleak detection (k = 0.3-0.64). Conclusions: The GRASP-VIBE MRA characterized by high spatial and temporal resolution demonstrates clinical feasibility with good image quality and superior diagnostic confidence. It notably enhances diagnostic performance in detecting and classifying endoleaks, particularly type II, compared to traditional multiphase CTA with inconclusive findings.
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Affiliation(s)
- Haidara Almansour
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
| | - Migdat Mustafi
- Klinik für Thoraxchirurgie-Lungentransplantation und Klinik für Kinderherzchirurgie, Universitätsklinikum des Saarlandes, 66421 Homburg, Germany;
| | - Mario Lescan
- Department of Cardiovascular Surgery, University Hospital Freiburg, 79106 Freiburg, Germany;
| | - Ulrich Grosse
- Department of Radiology, Cantonal Hospital Frauenfeld, Switzerland Pfaffenholzstrasse 4, 8500 Frauenfeld, Switzerland
| | - Mateja Andic
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Jörg Schmehl
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
- Diakonie Klinikum Stuttgart, Department for Radiology, 70176 Stuttgart, Germany
| | - Gerd Grözinger
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
| | - Sven S. Walter
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
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2
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Kazimierczak W, Kazimierczak N, Lemanowicz A, Nowak E, Migdalski A, Jawien A, Jankowski T, Serafin Z. Improved Detection of Endoleaks in Virtual Monoenergetic Images in Dual-Energy CT Angiography Following EVAR. Acad Radiol 2023; 30:2813-2824. [PMID: 37062628 DOI: 10.1016/j.acra.2023.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES The objective of this prospective study was to evaluate the virtual monoenergetic images (VMI) and virtual noncontrast (VNC) phase in the detection of endoleaks after endovascular abdominal aortic repair (EVAR). The potential dose reduction of abbreviated examination protocols was calculated. MATERIALS AND METHODS Ninety-seven patients after the EVAR procedure were enrolled in this study. An initial single-source noncontrast acquisition was followed by two dual-energy acquisitions (arterial and 60 s delayed). Fast-kVp switching scanner was used. VNC images were reconstructed from the delayed phase. First examination session (reference) included a full triphasic study protocol consisting of true noncontrast (TNC) images and two postcontrast phases, the latter ones presented as classical polyenergetic reconstructions. Reading sessions II and III were performed by two independent and blinded readers evaluating VMIs in abbreviated protocols-biphasic (VNC + arterial, delayed phase), monophasic (VNC + delayed phase). The diagnostic accuracy of sessions II and III was calculated. RESULTS The calculated sensitivity of the biphasic protocol with the use of VMIs in endoleak detection was 100%, with a statistically significant increase in the number of endoleaks detected in comparison with the reference study. The monophasic protocol showed 83.33% sensitivity. The use of abbreviated examination protocols led to a decrease in the mean effective dose (ED) of 23.28% (biphasic protocol) and 61.37% (monophasic protocol). CONCLUSION The use of VMIs increases the number of endoleaks diagnosed with a possible radiation reduction by up to ¼ (biphasic protocol). Further reduction to a monophasic protocol leads to over 60% dose reduction but with a decrease in diagnostic accuracy.
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Affiliation(s)
- Wojciech Kazimierczak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067.
| | | | - Adam Lemanowicz
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | - Ewa Nowak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | - Arkadiusz Migdalski
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | - Arkadiusz Jawien
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
| | | | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, Bydgoszcz, Poland 85-067
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3
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Contrella BN, Khaja MS, Majdalany BS, Kim CY, Kalva SP, Beck AW, Browne WF, Clough RE, Ferencik M, Fleischman F, Gunn AJ, Hickey SM, Kandathil A, Kim KM, Monroe EJ, Ochoa Chaar CI, Scheidt MJ, Smolock AR, Steenburg SD, Waite K, Pinchot JW, Steigner ML. ACR Appropriateness Criteria® Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up. J Am Coll Radiol 2023; 20:S265-S284. [PMID: 37236748 DOI: 10.1016/j.jacr.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
As the incidence of thoracoabdominal aortic pathology (aneurysm and dissection) rises and the complexity of endovascular and surgical treatment options increases, imaging follow-up of patients remains crucial. Patients with thoracoabdominal aortic pathology without intervention should be monitored carefully for changes in aortic size or morphology that could portend rupture or other complication. Patients who are post endovascular or open surgical aortic repair should undergo follow-up imaging to evaluate for complications, endoleak, or recurrent pathology. Considering the quality of diagnostic data, CT angiography and MR angiography are the preferred imaging modalities for follow-up of thoracoabdominal aortic pathology for most patients. The extent of thoracoabdominal aortic pathology and its potential complications involve multiple regions of the body requiring imaging of the chest, abdomen, and pelvis in most patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Charles Y Kim
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | - Sanjeeva P Kalva
- Panel Vice-Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam W Beck
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama; Society for Vascular Surgery
| | | | - Rachel E Clough
- St Thomas' Hospital, King's College, School of Biomedical Engineering and Imaging Science, London, United Kingdom; Society for Cardiovascular Magnetic Resonance
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Fernando Fleischman
- Keck School of Medicine of USC, Los Angeles, California; American Association for Thoracic Surgery
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Sean M Hickey
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; American College of Emergency Physicians
| | - Asha Kandathil
- UT Southwestern Medical Center, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Karen M Kim
- University of Michigan, Ann Arbor, Michigan; The Society of Thoracic Surgeons
| | | | | | | | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | - Jason W Pinchot
- Specialty Chair, University of Wisconsin, Madison, Wisconsin
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4
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Abstract
Endoleak remains a significant challenge to endovascular aneurysm repair, particularly as evolving techniques and devices have allowed treatment of increasingly complex aneurysm anatomy with increasing number of device components. Intervention is recommended for both type I and III endoleaks due to their risk of rupture, and endovascular techniques are the favored modality with placement of a bridging endograft over the endoleak defect. Conversion to open surgical repair remains the definitive option in cases where less invasive methods have failed or are precluded. In this article, the authors review evidence on the etiology, incidence, diagnosis, and current techniques for type III endoleak management.
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Affiliation(s)
- Jordan B. Stoecker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia D. Glaser
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
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5
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Daye D, Walker TG. Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management. Cardiovasc Diagn Ther 2018; 8:S138-S156. [PMID: 29850426 DOI: 10.21037/cdt.2017.09.17] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In recent decades, endovascular aneurysm repair or endovascular aortic repair (EVAR) has become an acceptable alternative to open surgery for the treatment of thoracic and abdominal aortic aneurysms and other aortic pathologies such as the acute aortic syndromes (e.g., penetrating aortic ulcer, intramural hematoma, dissection). Available data suggest that endovascular repair is associated with lower perioperative 30-day all-cause mortality as well as a significant reduction in perioperative morbidity when compared to open surgery. Additionally, EVAR leads to decreased blood loss, eliminates the need for cross-clamping the aorta and has shorter recovery periods than traditional surgery. It is currently the preferred mode of treatment of thoracic and abdominal aortic aneurysms in a subset of patients who meet certain anatomic criteria conducive to endovascular repair. The main disadvantage of EVAR procedures is the high rate of post-procedural complications that often require secondary re-intervention. As a result, most authorities recommend lifelong imaging surveillance following repair. Available surveillance modalities include conventional radiography, computed tomography, magnetic resonance angiography, ultrasonography, nuclear imaging and conventional angiography, with computed tomography currently considered to be the gold standard for surveillance by most experts. Following endovascular abdominal aortic aneurysm (AAA) repair, the rate of complications is estimated to range between 16% and 30%. The complication rate is higher following thoracic EVAR (TEVAR) and is estimated to be as high as 38%. Common complications include both those related to the endograft device and systemic complications. Device-related complications include endoleaks, endograft migration or collapse, kinking and/or stenosis of an endograft limb and graft infection. Post-procedural systemic complications include end-organ ischemia, cerebrovascular and cardiovascular events and post-implantation syndrome. Secondary re-interventions are required in approximately 19% to 24% of cases following endovascular abdominal and thoracic aortic aneurysm repair respectively. Typically, most secondary reinterventions involve the use of percutaneous techniques such as placement of cuff extension devices, additional endograft components or stents, enhancement of endograft fixation, treatment of certain endoleaks using various embolization techniques and embolic agents and thrombolysis of occluded endograft components. Less commonly, surgical conversion and/or open surgical modification are required. In this article, we provide an overview of the most common complications that may occur following endovascular repair of thoracic and AAAs. We also summarize the current surveillance recommendations for detecting and evaluating these complications and discuss various current secondary re-intervention approaches that may typically be employed for treatment.
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Affiliation(s)
- Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - T Gregory Walker
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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6
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Abstract
There is a significant risk of complication following endovascular abdominal repair (EVAR), including endoleak, graft translocation, thrombosis, and infection. Surveillance imaging is important for detecting EVAR complication. Surveillance modalities include conventional X-ray, computed tomography, magnetic resonance imaging, ultrasound, and conventional angiography, with inherent advantages and drawbacks to each modality. The authors present common complications following EVAR, and recent advances in the key modalities for surveillance.
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Affiliation(s)
- Nirnimesh Pandey
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I Litt
- Department of Radiology, Cardiovascular Imaging Section, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Nicola R, Shaqdan KW, Aran S, Singh AK, Abujudeh HH. Detecting Aortic Graft Complications: A Spectrum of Computed Tomography Findings. Curr Probl Diagn Radiol 2015; 45:330-9. [PMID: 26321311 DOI: 10.1067/j.cpradiol.2015.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/22/2022]
Abstract
Endovascular aneurysm repair (EVAR) is a successful technique as well as an excellent alternative to the surgical management of abdominal aortic aneurysms. EVAR has improved the mortality and morbidity of many patients who would have otherwise suffered greatly from the consequences of abdominal aortic aneurysms. However, EVAR is not without complications. Some complications require lifelong surveillance, whereas others may necessitate immediate surgical intervention. We discuss the various modalities available for the surveillance as well as the common complications that can be seen on computed tomography.
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Affiliation(s)
- Refky Nicola
- Division of Emergency Imaging, University of Rochester Medical Center, Rochester, NY
| | - Khalid W Shaqdan
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA
| | - Shima Aran
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA
| | - Ajay K Singh
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA
| | - Hani H Abujudeh
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA.
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8
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Thakor AS, Tanner J, Ong SJ, Hughes-Roberts Y, Ilyas S, Cousins C, See TC, Klass D, Winterbottom AP. Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair. Can Assoc Radiol J 2015; 66:277-90. [PMID: 25978867 DOI: 10.1016/j.carj.2014.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023] Open
Abstract
Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.
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Affiliation(s)
- Avnesh S Thakor
- Department of Interventional Radiology, Stanford University, Stanford University Medical Center, Palo Alto, California, USA
| | - James Tanner
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shao J Ong
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Ynyr Hughes-Roberts
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shahzad Ilyas
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Claire Cousins
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Teik C See
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Darren Klass
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew P Winterbottom
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
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9
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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:119-82. [DOI: 10.1016/j.echo.2014.11.015] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Abstract
Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR.
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Affiliation(s)
- Dominique B Buck
- 1] Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. [2] Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, 110 Francis Street Suite B, Boston, MA 02215, USA
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, 110 Francis Street Suite B, Boston, MA 02215, USA
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
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11
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Habets J, Zandvoort HJA, Reitsma JB, Bartels LW, Moll FL, Leiner T, van Herwaarden JA. Magnetic resonance imaging is more sensitive than computed tomography angiography for the detection of endoleaks after endovascular abdominal aortic aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg 2013; 45:340-50. [PMID: 23403221 DOI: 10.1016/j.ejvs.2012.12.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 12/21/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of this systematic review was to examine whether magnetic resonance imaging (MRI) or computed tomography angiography (CTA) is more sensitive for the detection of endoleaks in patients with abdominal aortic aneurysm (AAA) after EVAR. DESIGN Systematic review. MATERIALS AND METHODS A systematic electronic search was performed. Articles were included when post-EVAR patients were evaluated by both MRI as index test and CTA as comparison. Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Primary outcome was the proportion of patients in whom MRI detected additional endoleaks, which were not seen with CTA. RESULTS Eleven articles were included. The overall methodological quality of the articles was good. In total, 369 patients with 562 MRI and 562 CTA examinations were included. A total of 146 endoleaks were detected by CTA; MRI detected all but two of these endoleaks. With MRI 132 additional endoleaks were found. CONCLUSIONS MRI is more sensitive compared to CTA for the detection of post-EVAR endoleaks, especially for the detection of type II endoleaks. MRI should be considered in patients with continued AAA growth and negative or uncertain findings at CTA.
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Affiliation(s)
- J Habets
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3508 GA Utrecht, The Netherlands.
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12
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Sommer WH, Becker CR, Haack M, Rubin GD, Weidenhagen R, Schwarz F, Nikolaou K, Reiser MF, Johnson TR, Clevert DA. Time-resolved CT Angiography for the Detection and Classification of Endoleaks. Radiology 2012; 263:917-26. [DOI: 10.1148/radiol.12111217] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Resta EC, Secchi F, Giardino A, Nardella VG, Di Leo G, Flor N, Sardanelli F. Non-contrast MR imaging for detecting endoleak after abdominal endovascular aortic repair. Int J Cardiovasc Imaging 2012; 29:229-35. [PMID: 22588711 DOI: 10.1007/s10554-012-0060-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/28/2012] [Indexed: 01/24/2023]
Abstract
Our aim was to investigate the possibility of ruling out endoleak after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) using non-contrast MRI. Twenty-three patients (20 males, aged 73 ± 8 years) with an EVAR-treated AAA underwent 1.5-T MRI using axial, coronal and sagittal oblique true-FISP sequences. Two blinded and independent readers with 4 (R1) and 2 (R2) years of experience evaluated these images considering an area of even less than 5 mm in diameter with a signal intensity higher than that of normal muscles visible in the excluded aneurysmal sac as a sign of potential endoleak. The final assessment, mainly based on MR angiography and previous examinations, served as reference standard. Out of 23 patients, 13 (57%) were negative for endoleak at final assessment, while the remaining 10 (43%) were positive, with the following type distribution: Ia (n = 4), Ib (n = 2), II (n = 3), and III (n = 1). Sensitivity was 10/10 (100%; CI 95% 69-100%), specificity 7/13 (54%; 25-81%), accuracy 17/23 (74%; 52-90%), PPV 10/16 (63%; 35-85%) and NPV 7/7 (100%; 59-100%) for R1; 9/10 (90%; 56-100%), 8/13 (62%; 32-86%), 17/23 (74%; 52-90%), 9/14 (64%; 35-8%), and 8/9 (89%; 52-100%) for R2, respectively. Inter-reader Cohen κ was 0.810. A negative non-contrast true-FISP MR study can be used to rule out endoleak after EVAR of AAA. This hypothesis may contribute to the reduction of ionizing radiation exposure and contrast material administration for monitoring patients with an EVAR-treated AAA.
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Affiliation(s)
- Elda C Resta
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
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14
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Shah A, Stavropoulos SW. Imaging Surveillance following Endovascular Aneurysm Repair. Semin Intervent Radiol 2011; 26:10-6. [PMID: 21326526 DOI: 10.1055/s-0029-1208378] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endoleaks are unique complications of endovascular aneurysm repair (EVAR) that necessitate lifelong imaging surveillance for the patient. Several imaging modalities may be used to monitor the patient for endoleaks and other complications related to the stent graft. At present, computed tomographic angiography remains the gold standard for the detection of endoleaks. Other modalities that can be used to detect endoleaks include magnetic resonance, ultrasonography, nuclear medicine techniques, and pressure monitoring. In addition, follow-up imaging with digital subtraction angiography is important for endoleak classification and to guide decisions regarding therapy. In this article, we review the classification of endoleaks and discuss the different imaging strategies available for post-EVAR surveillance.
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Affiliation(s)
- Anand Shah
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Walker TG, Kalva SP, Yeddula K, Wicky S, Kundu S, Drescher P, d'Othee BJ, Rose SC, Cardella JF. Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:1632-55. [DOI: 10.1016/j.jvir.2010.07.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/24/2010] [Accepted: 07/11/2010] [Indexed: 12/17/2022] Open
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Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg 2010; 52:1022-33, 1033.e15. [DOI: 10.1016/j.jvs.2010.07.008] [Citation(s) in RCA: 480] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 07/11/2010] [Accepted: 07/14/2010] [Indexed: 11/22/2022]
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Abstract
PURPOSE The aim of this study was to test the feasibility and the additional value of time-resolved computed tomography angiography (CTA) of the aorta, using multiple low-dose phases. MATERIALS AND METHODS Twenty-two consecutive patients underwent a time-resolved CTA protocol (TR-CTA) of the aorta, either for follow-up of endovascular aneurysm repair (EVAR) or aortic dissection, using a CT scanner with the possibility of bidirectional table movements for dynamic CT imaging (Siemens Definition AS+; 12 phases, temporal resolution 2.5 s/scan, 80 kVp, 120 mAs/rot, scan range 27 cm, 60 mL; Imeron 400, flow 5.0 mL/s). The patients had previously undergone standard CTA (120 kVp, 100 mL contrast agent). Standard CTA after EVAR and aortic dissection were triphasic and biphasic protocols, respectively. Effective radiation dose and maximum Hounsfield unit values were compared between the TR-CTA and standard CTA. Image quality was rated for TR-CTA. RESULTS Fifteen patients underwent TR-CTA for follow-up after EVAR; 4 were examined for follow-up after dissection and 3 for both, that is, aortic dissection treated with an endovascular stent. Mean effective dose of TR-CTA for the scan range of 27 cm (15.3+/-1.1 mSv) was comparable with the biphasic standard CTA protocols (16.2+/-2.4 mSv; P=0.29). Triphasic protocols resulted in 23.7+/-4.9 mSv (P<0.0001). Hounsfield unit values were not significantly different. Most of the examinations (91%) were fully evaluable, whereas 9% were of limited evaluability because of high image noise. None of the examinations was nondiagnostic. DISCUSSION TR-CTA consisting of multiple low-dose phases leads to a clear depiction of the angiographic information and is feasible for follow-up after EVAR and aortic dissection. Considering the limited scan range, radiation dose is comparable with the standard biphasic CTA protocol, but dynamic information may provide additional information.
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Kramer U, Fenchel M, Laub G, Seeger A, Klumpp B, Bretschneider C, Finn JP, Claussen CD, Miller S. Low-dose, time-resolved, contrast-enhanced 3D MR angiography in the assessment of the abdominal aorta and its major branches at 3 Tesla. Acad Radiol 2010; 17:564-76. [PMID: 20171907 DOI: 10.1016/j.acra.2009.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/08/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES The aims of this study were to evaluate the effectiveness of low-dose, contrast-enhanced (CE), time-resolved, three-dimensional magnetic resonance angiography (MRA) in the assessment of the abdominal aorta and its major branches at 3 T and to compare the results with those of high-spatial resolution CE MRA. MATERIALS AND METHODS Twenty-two consecutive patients (eight men, 14 women; mean age, 43.9 +/- 17.9 years) underwent CE time-resolved three-dimensional MRA and high-spatial resolution three-dimensional MRA. Studies were performed using a 3-T magnetic resonance system; gadolinium-based contrast medium was administered at a dose of 3 to 5 mL for time-resolved MRA, followed by 0.1 mmol/kg gadopentetate dimeglumine for single-phase CE MRA. For analysis purposes, the abdominal arterial system was divided into 11 arterial segments, and image quality as well as the presence and degree of vascular pathology were evaluated by two independent magnetic resonance radiologists. RESULTS A total of 242 arterial segments were visualized with good image quality. Time-resolved MRA was able to visualize the majority of arterial segments with good definition in the diagnostic range. Vascular pathologies (stenosis, occlusion) or abnormal vascular anatomy was detected in 19 arterial segments, with good interobserver agreement (kappa = 0.78). All image findings were detected with time-resolved CE MRA by both observers and were confirmed by correlative imaging. CONCLUSION Low-dose, time-resolved MRA at 3 T yields rapid and important anatomic and functional information in the evaluation of the abdominal vasculature. Because of its limited spatial resolution, time-resolved MRA is inferior to CE MRA in demonstrating fine vascular details.
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Sommer WH, Graser A, Becker CR, Clevert DA, Reiser MF, Nikolaou K, Johnson TR. Image Quality of Virtual Noncontrast Images Derived from Dual-energy CT Angiography after Endovascular Aneurysm Repair. J Vasc Interv Radiol 2010; 21:315-21. [DOI: 10.1016/j.jvir.2009.10.040] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 10/14/2009] [Accepted: 10/17/2009] [Indexed: 11/29/2022] Open
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Gleason TG. Endoleaks After Endovascular Aortic Stent-Grafting: Impact, Diagnosis, and Management. Semin Thorac Cardiovasc Surg 2009; 21:363-72. [DOI: 10.1053/j.semtcvs.2009.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 11/11/2022]
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Griffin M, Grist TM, François CJ. Dynamic Four-Dimensional MR Angiography of the Chest and Abdomen. Magn Reson Imaging Clin N Am 2009; 17:77-90. [DOI: 10.1016/j.mric.2008.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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