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Yang Q, Hu J, Luo Y, Jia D, Chen N, Yao C, Wu R. Detection of Endoleak after Endovascular Aortic Repair through Deep Learning Based on Non-contrast CT. Cardiovasc Intervent Radiol 2024; 47:1267-1275. [PMID: 38977447 DOI: 10.1007/s00270-024-03805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To develop and validate a deep learning model for detecting post-endovascular aortic repair (EVAR) endoleak from non-contrast CT. METHODS This retrospective study involved 245 patients who underwent EVAR between September 2016 and December 2022. All patients underwent both non-enhanced and enhanced follow-up CT. The presence of endoleak was evaluated based on computed tomography angiography (CTA) and radiology reports. First, the aneurysm sac was segmented, and radiomic features were extracted on non-contrast CT. Statistical analysis was conducted to investigate differences in shape and density characteristics between aneurysm sacs with and without endoleak. Subsequently, a deep learning model was trained to generate predicted segmentation of the endoleak. A binary decision was made based on whether the model produced a segmentation to detect the presence of endoleak. The absence of a predicted segmentation indicated no endoleak, while the presence of a predicted segmentation indicated endoleak. Finally, the performance of the model was evaluated by comparing the predicted segmentation with the reference segmentation obtained from CTA. Model performance was assessed using metrics such as dice similarity coefficient, sensitivity, specificity, and the area under the curve (AUC). RESULTS This study finally included 85 patients with endoleak and 82 patients without endoleak. Compared to patients without endoleak, patients with endoleak had higher CT values and greater dispersion. The AUC in validation group was 0.951, dice similarity coefficient was 0.814, sensitivity was 0.877, and specificity was 0.884. CONCLUSION This deep learning model based on non-contrast CT can detect endoleak after EVAR with high sensitivity.
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Affiliation(s)
- Qingqi Yang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jinglang Hu
- School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Yingqi Luo
- Department of Medical Imaging, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Dongdong Jia
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Nuo Chen
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chen Yao
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ridong Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Accarino G, Benenati A, Accarino G, De Vuono F, Fornino G, Galasso G, Bracale UM. Endovascular treatment of an aortocaval fistula caused by a late type II endoleak. J Vasc Surg Cases Innov Tech 2024; 10:101436. [PMID: 38435789 PMCID: PMC10907850 DOI: 10.1016/j.jvscit.2024.101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2024] Open
Abstract
An aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAAs) and constitute <1% of all AAAs, which increases from 2% to 6.7% in ruptured AAAs. Unlike other aortic ruptures, most ACFs are not associated with significant blood loss on admission. The traditional treatment strategy has been open surgery, which is associated with a high mortality rate. Endovascular repair has been performed; however, the results are difficult to interpret due to the low incidence of ACFs and the absence of cases reported with a long follow-up duration. We report the case of a 78-year-old man with previous endovascular aneurysm repair performed in 2015, who presented to our emergency department 6 years later with abdominal pain. A computed tomography angiography scan showed type Ia, Ib, and II endoleaks and an ACF. The endoleaks were selectively treated, and the ACF was covered with a polytetrafluoroethylene endograft inserted in the inferior vena cava. In our single-case experience with a medium-term follow-up of 24 months, our treatment was safe and effective for ACF closure, with no further signs of endoleak or graft thrombosis. We conducted a literature review of reported cases in which a covered stent graft was used for ACF treatment. Although no guidelines are currently available regarding this rare late complication after endovascular aneurysm repair, using a covered stent placed in the inferior vena cava to treat an ACF could be a viable option in selected cases.
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Affiliation(s)
- Giulio Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Alessandra Benenati
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Giancarlo Accarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Francesco De Vuono
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giovanni Fornino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Umberto Marcello Bracale
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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McDonald M, Robinson E, Singh H. Staged triple endovascular approach for repair of aortocaval fistula secondary to ruptured abdominal aortic aneurysm. J Vasc Surg Cases Innov Tech 2023; 9:101335. [PMID: 38023326 PMCID: PMC10654583 DOI: 10.1016/j.jvscit.2023.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
A primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms caused by erosion of the aortic wall into the vena cava. It is more frequently observed in the setting of ruptured abdominal aortic aneurysms and presents a unique challenge for vascular surgeons. Both open and endovascular techniques exist, with the main differences being perioperative mortality and recurrence rates. We present a case of an ACF diagnosed intraoperatively, which persisted after endovascular aneurysm repair in conjunction with a type II endoleak. We applied a unique staged, triple endovascular approach to close the ACF via caval and aortic exclusion of inflow and outflow vessels.
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Affiliation(s)
- Molly McDonald
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
| | - Eric Robinson
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
| | - Harmandeep Singh
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
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Sohail AH, Cohen K, Ho K, Cimaroli S, Brathwaite CEM, Shin P. Incidental aortocaval fistula in the setting of an unruptured abdominal aortic aneurysm. J Surg Case Rep 2023; 2023:rjad384. [PMID: 37416494 PMCID: PMC10319617 DOI: 10.1093/jscr/rjad384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
An aortocaval fistula, a rare abnormal vascular communication between the aorta and inferior vena cava, is most commonly associated with abdominal aortic aneurysms (AAAs). Other factors leading to aortocaval fistula formation include atherosclerosis, collagen vascular diseases, vasculitis, hematogenous infections, prior spinal surgery, malignancy and radiation exposure. In rare instances, aortocaval fistulas may be discovered incidentally on abdominal imaging. We report an unusual case of an incidental aortocaval fistula in a 93-year-old male patient with an unruptured AAA, presenting with shortness of breath, malaise and lethargy. The patient had no other obvious risk factors for aortocaval fistula formation. Multidetector computed tomography angiography helped identify the fistula, and the patient was eventually transferred to hospice for comfort measures. This case highlights the importance of detailed imaging and preoperative planning in managing aortocaval fistulas and associated AAAs.
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Affiliation(s)
- Amir H Sohail
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Koral Cohen
- Correspondence address. Department of General Surgery, NYU Long Island School of Medicine, Mineola, NY, USA. Tel: 201-414-2434; Fax: 516-663-8707; E-mail:
| | - Kimberly Ho
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Sawyer Cimaroli
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | | | - Patrick Shin
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
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